NPI age
19 years
Enumerated 2007-01-24
Across 1099 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1970 | DELTA |
| 01 (ID) | 62539 | BCBS |
| 01 (ID) | 48148 | BS |
| 01 (ID) | 820487001 | FED TAX ID |
| 01 (ID) | 48148 | BS# |
| 01 (ID) | 6253-9 | BX |
| 01 (ID) | D 1970 | LICENSE |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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