NPI age
17 years
Enumerated 2008-10-07
Across 135 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 60301 | BLUE CROSS OF ID |
| 05 (ID) | 002584200 | |
| 01 | 840380 | UNITED CONCORDIA |
| 05 (WY) | 113353500 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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