NPI age
19 years
Enumerated 2007-01-23
Across 591 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (NV) | 002288154 | |
| 05 (ID) | 001184500 |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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