NPI age
19 years
Enumerated 2006-08-18
Across 591 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 633218 | UNITED CONCORDIA |
| 01 (UT) | 82049457412002 | BLUE CROSS/BLUE SHIELD |
| 05 (ID) | 0027325 |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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