NPI age
17 years
Enumerated 2008-06-04
Across 1099 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002640700 | |
| 01 (PA) | 779347 | UNITED CONCORDIA |
| 01 (ID) | 10009571 | REGENCE BLUE CROSS |
| 01 (ID) | 61192 | BLUE CROSS OF IDAHO |
Single-site organization. Only one practice location on file.
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