NPI age
19 years
Enumerated 2006-10-17
Across 1099 active dentist providers in Idaho.
1 individual provider on file at this primary practice address.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 000789200 | |
| 01 (ID) | 462879 | UNITED CONCORDIA |
| 01 (ID) | 6C396 | BLUE CROSS |
Multi-provider organization. 1 individual provider on file at this primary address.
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