Lawrence John Child, DDS, PC
Individual provider Active NPI General Practice Dentistry · Gooding, ID
NPI 1811099765 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811099765
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D1473 (ID)
- Practice address
- 126 5TH Ave W
Gooding, ID 83330-1202 - Phone
- (208) 934-4610
- Fax
- (208) 934-0901
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| D1473 | ID | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D1473 | ID | Yes |
Addresses
Primary practice location
126 5TH Ave W
Gooding, ID 83330-1202
Mailing address
126 5TH Ave W
Gooding, ID 83330-1202
Phone (208) 934-4610
Other providers in Gooding, ID
- Carefix Management and Consulting, Inc.
- Carma Carson
- Kylee Casper
- Charolais Care VII Inc
- Kevin Cherry
- David Circuit Christiansen
- Joshua D Cooke
- County of Gooding
- County of Gooding School Dist 231 Class a
- Dargreen Power Systems
All providers in Gooding, 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.