NPI age
17 years
Enumerated 2008-06-10
Across 1099 active dentist providers in Idaho.
2 individual providers on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (OR) | 022470 | |
| 05 (ID) | 002768200 |
Multi-provider organization. 2 individual providers on file at this primary address.
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