Millennium Family Dental - Boise LLC

NPI #1104925064 in Boise, Idaho

Provider Information

NPI Number: 1104925064
Entity Type: Organization
Organization Name: Millennium Family Dental - Boise LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Sep 21, 2006
Last Updated: Dec 30, 2014

Practice Location

Address: 813 STILSON RD
Address 2: SUITE B
City: Boise
State: Idaho
ZIP Code: 83703
Phone: (208) 342-4644

Authorized Official

Name: JENNIFER LYNN VIQUELIA
Title: OFFICE MANAGER
Phone: (208) 888-2026

Specialties & Taxonomy Codes

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

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