NPI age
15 years
Enumerated 2011-01-31
Across 1099 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 8061442 | |
| 01 (ID) | CS9245 | ID STATE BOARD OF PHARMACY |
| 01 (ID) | 1312746 | UNITED CONCORDIA |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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