NPI age
20 years
Enumerated 2006-05-23
Across 114 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | D-3592-PD | STATE DENTAL LICENSE |
| 05 (ID) | 806274800 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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