NPI age
18 years
Enumerated 2008-03-19
Across 591 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 0013359 | |
| 01 (ID) | D-1820 | ID DENTAL LICENSE |
Part of a multi-provider practice. 11 other active providers share this practice address in NPPES.
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