NPI age
19 years
Enumerated 2006-08-01
Across 1099 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 61937 | BLUE CROSS ID PAYEE NUMBE |
| 05 (ID) | 000504200 |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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