Provider Demographics
NPI:1215426689
Name:TWIN FALLS KIDS DENTAL LLC
Entity type:Organization
Organization Name:TWIN FALLS KIDS DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-724-3647
Mailing Address - Street 1:1411 FALLS AVE E STE 1000C
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3459
Mailing Address - Country:US
Mailing Address - Phone:208-734-7415
Mailing Address - Fax:
Practice Address - Street 1:1186 EASTLAND DR N STE B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8973
Practice Address - Country:US
Practice Address - Phone:208-733-9331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty