Provider Demographics
NPI:1700874567
Name:GARDIPE, EVIE L
Entity Type:Individual
Prefix:MRS
First Name:EVIE
Middle Name:L
Last Name:GARDIPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:WORLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83876-0129
Mailing Address - Country:US
Mailing Address - Phone:208-686-1110
Mailing Address - Fax:208-686-0242
Practice Address - Street 1:1115 B ST
Practice Address - Street 2:
Practice Address - City:PLUMMER
Practice Address - State:ID
Practice Address - Zip Code:83851-0388
Practice Address - Country:US
Practice Address - Phone:208-686-1931
Practice Address - Fax:208-686-0242
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant