NPI age
20 years
Enumerated 2005-09-07
Across 114 active dentist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (IL) | 6N474 | BLUE CROSS PROVIDER ID |
| 01 (ID) | 000010151637 | BLUE SHIELD PROVIDER ID |
| 05 (ID) | 807215900 |
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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