An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
taxonomy 1223P0221X
Identifiers
Type
Value
Notes
05 (ID)
807793700
01 (ID)
6P475
BLUECROSS OF IDAHO
01
9202516
MEDICAID - IDAHO SMILES
01 (ID)
000010165079
REGENCE BLUESHIELD OF ID
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
Madison Pediatric Dentistry
Type code 3recorded 2016-02-12
Practice context
Multi-provider organization.
1 individual provider on file at this primary address.
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