NPI age
20 years
Enumerated 2006-03-16
Across 1099 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1428313 | UNITED CONCORDIA PROV. # |
| 05 (ID) | 206330700 |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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