Provider Demographics
NPI:1952316341
Name:ASPEN VALLEY FAMILY DENTISTRY
Entity type:Organization
Organization Name:ASPEN VALLEY FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-523-4181
Mailing Address - Street 1:3423 MERLIN DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-523-4181
Mailing Address - Fax:208-523-4182
Practice Address - Street 1:3423 MERLIN DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-523-4181
Practice Address - Fax:208-523-4182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty