Boise Smiles Youth Dentistry, Pllc

NPI #1033154604 in Boise, Idaho

Provider Information

NPI Number: 1033154604
Entity Type: Organization
Organization Name: Boise Smiles Youth Dentistry, Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 18, 2006
Last Updated: Jul 9, 2014

Practice Location

Address: 8744 FAIRVIEW AVE
City: Boise
State: Idaho
ZIP Code: 83704-8207
Phone: (208) 322-3010

Authorized Official

Name: MRS. JENELL STUMP
Title: MANAGER, LICENSING & CREDENTIALING
Phone: (615) 750-0343

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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