Idaho Dental Professionals, P.c.

NPI #1114532645 in Boise, Idaho

Provider Information

NPI Number: 1114532645
Entity Type: Organization
Organization Name: Idaho Dental Professionals, P.c.
Subpart: Yes (part of a larger organization)
Parent Organization: HEARTLAND DENTAL
Primary Specialty: Dentist - General Practice
Enumeration Date: Sep 11, 2020
Last Updated: Sep 11, 2020

Practice Location

Address: 2803 N BOGUS BASIN RD
City: Boise
State: Idaho
ZIP Code: 83702-0913
Phone: (208) 343-1393

Authorized Official

Name: TABATHA LEMKE
Title: CREDENTIALING COORDINATOR
Phone: (217) 540-6078

Specialties & Taxonomy Codes

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

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