Provider Demographics
NPI:1679817241
Name:GNEITING, DEVIN THEODORE (DMD)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:THEODORE
Last Name:GNEITING
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 N CLIFF CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1037
Mailing Address - Country:US
Mailing Address - Phone:208-270-4121
Mailing Address - Fax:
Practice Address - Street 1:742 N CLIFF CREEK LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1037
Practice Address - Country:US
Practice Address - Phone:208-270-4121
Practice Address - Fax:254-753-0315
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-54421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice