Provider Demographics
NPI:1972863678
Name:DENTAL CARE FOR KIDS
Entity Type:Organization
Organization Name:DENTAL CARE FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:WHITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-888-7711
Mailing Address - Street 1:3235 N TOWERBRIDGE WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5721
Mailing Address - Country:US
Mailing Address - Phone:208-888-7711
Mailing Address - Fax:208-888-3089
Practice Address - Street 1:3235 N TOWERBRIDGE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5721
Practice Address - Country:US
Practice Address - Phone:208-888-7711
Practice Address - Fax:208-888-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-38681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDD4065OtherIDAHO LICENSE