NPI age
19 years
Enumerated 2006-07-28
Across 591 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 | 143053 | UNITED CONCORDIA |
| 01 (ID) | 40144 | BLUE SHIELD |
| 01 (ID) | 68387 | BLUE CROSS |
| 05 (ID) | 0022165 |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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