NPI age
19 years
Enumerated 2006-09-20
Across 135 active dentist providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (CA) | 57194 | CALIFORNIA DENTAL LICENSE NUMBER |
| 01 (ID) | D-3908-OR | IDAHO DENTAL LICENSE NUMBER |
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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