NPI age
18 years
Enumerated 2008-02-26
Across 1099 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 6C396 | BLUE CROSS |
| 05 (ID) | 000789200 | |
| 01 (ID) | 462879 | UNITED CONCORDIA |
Solo or small practice. No other active providers share this practice address in NPPES.
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