NPI age
19 years
Enumerated 2006-11-01
Across 591 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002667500 | |
| 01 (ID) | 41383 | BLUE SHIELD |
| 01 (ID) | 60194 | BLUE CROSS |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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