Provider Demographics
NPI:1427618958
Name:EASTERN IDAHO ENDODONTICS
Entity type:Organization
Organization Name:EASTERN IDAHO ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ENDODONTISTS
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-524-3770
Mailing Address - Street 1:3335 S. HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-524-3770
Mailing Address - Fax:208-524-3795
Practice Address - Street 1:3335 S. HOLMES AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-524-3770
Practice Address - Fax:208-524-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty