Bryce Christofer Killian, D.D.S.
Individual provider Active NPI General Practice Dentistry · Paul, ID
NPI 1609971928 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1609971928
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D-3272 (ID)
- Practice address
- 207 W. Ellis St.
Paul, ID 83347 - Phone
- (208) 438-4855
- Fax
- (208) 438-4835
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-3272 | ID | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Dental Care Paul, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D-3272 | ID | Yes |
Addresses
Primary practice location
207 W. Ellis St.
Paul, ID 83347
Mailing address
PO Box 549
Paul, ID 83347-0549
Phone (208) 438-4855
Other providers in Paul, ID
All providers in Paul, ID · General Practice Dentistry in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.