Jason Champagne Idaho 5, Pllc

NPI #1114775640 in Boise, Idaho

Provider Information

NPI Number: 1114775640
Entity Type: Organization
Organization Name: Jason Champagne Idaho 5, Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: May 9, 2024
Last Updated: May 9, 2024

Practice Location

Address: 5993 W STATE ST STE B
City: Boise
State: Idaho
ZIP Code: 83703-5058
Phone: (208) 939-1700

Authorized Official

Name: JASON CHAMPAGNE, DDS
Title: OWNER
Phone: (775) 359-3934

Specialties & Taxonomy Codes

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

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