Facts
- Status
- A
- Credential
- D.M.D.
- Type
- Individual
- Enumeration date
- 2006-08-02
- Last updated
- 2015-11-25
Specialties
Licenses
- License ID
- D-3876
Location
- Practice location
- 711 RIGBY LAKE DR. #102
- City
- RIGBY ID
- Postal code
- 83442
- Phone
- 208-745-8788
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.