Provider Demographics
NPI:1184482317
Name:SAWTOOTH PERIODONTICS PLLC
Entity type:Organization
Organization Name:SAWTOOTH PERIODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSEANES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:843-530-4854
Mailing Address - Street 1:4681 S MARTINEL WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7341
Mailing Address - Country:US
Mailing Address - Phone:843-530-4854
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8856
Practice Address - Country:US
Practice Address - Phone:208-971-4989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty