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EDGEWATER DENTAL

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Company Details

Name: EDGEWATER DENTAL
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 26 Dec 2006 (19 years ago)
Entity Number: 328957
Place of Formation: IDAHO
File Number: 0000328957
ZIP code: 83686
County: Canyon County
Mailing Address: 1436 S EDGEWATER CIRCLE NAMPA, ID 83686

National Provider Identifier

NPI Number:
1891967659

Authorized Person:

Name:
RHONDA MILICH
Role:
RECEPTIONIST
Phone:

Taxonomy:

Selected Taxonomy:
302R00000X - Health Maintenance Organization
Is Primary:
Yes

Contacts:

Fax:
2084613156

Filing

Filing Name Filing Number Filing date
Initial Filing 0000328957 2006-12-26

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State