Intermountain Dental Specialists

NPI #1134522535 in Boise, Idaho

Provider Information

NPI Number
1134522535
Entity Type
Organization
Organization Name
Intermountain Dental Specialists
Primary Specialty
Clinic/Center - Dental
Enumeration Date
Sep 30, 2014
Last Updated
Sep 30, 2014

Practice Location

Address
12249 W MCMILLAN RD
City
Boise
State
Idaho
ZIP Code
83713-0555
Phone
(208) 917-2855

Authorized Official

Name
DR. JERRY MICHAEL CARBONE, D.M.D
Title
MANAGING MEMBER
Phone
(208) 917-2855

Specialties & Taxonomy Codes

Specialty
Clinic/Center - DentalDental

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