Provider Demographics
NPI:1295295152
Name:NORTH IDAHO FAMILY DENTISTRY
Entity type:Organization
Organization Name:NORTH IDAHO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-267-0203
Mailing Address - Street 1:6503 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-8619
Mailing Address - Country:US
Mailing Address - Phone:208-267-0203
Mailing Address - Fax:208-943-3161
Practice Address - Street 1:6503 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8619
Practice Address - Country:US
Practice Address - Phone:208-267-0203
Practice Address - Fax:208-943-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental