NPI age
20 years
Enumerated 2006-05-22
Across 1099 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 0017744400 | |
| 01 (ID) | 836142 | UNITED CONCORDIA TDP |
| 01 (ID) | 1000932 | REGENCE BLUE SHIELD |
| 01 (ID) | 6201-8 | BLUE CROSS |
Solo or small practice. No other active providers share this practice address in NPPES.
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