NPI age
19 years
Enumerated 2006-07-13
Across 591 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (OR) | D8744 | DENTAL LICENSE |
| 01 (ID) | D-4031 | DENTAL LICENSE |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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