| Organization Name: | DR. DANCE, DENTISTRY FOR KIDS |
| NPI Number: | 1548637994 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS DANCE (OWNER) |
| Mailing Address: | 1027 W Prairie Ave Hayden |
| State: | ID US |
| Postal Code: | 838354900 |
| Phone Number: | 2087722202 |
| Fax Number: | 2087722213 |
| NPI Enumeration Date: | 09/01/2015 |
| NPI Last Update Date: | 09/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D-4050-PD |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |