NPI age
19 years
Enumerated 2006-08-19
Across 1099 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 82049457413002 | BLUE CROSS/BLUE SHIELD UT |
| 01 (ID) | 576387 | UNITED CONCORDIA |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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