Idaho Dental Professionals, P.c.

NPI #1487230009 in Boise, Idaho

Provider Information

NPI Number: 1487230009
Entity Type: Organization
Organization Name: Idaho Dental Professionals, P.c.
Subpart: Yes (part of a larger organization)
Parent Organization: IDAHO DENTAL PROFESSIONALS, P.C.
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 23, 2021
Last Updated: Mar 23, 2021

Practice Location

Address: 6085 N EAGLE RD
City: Boise
State: Idaho
ZIP Code: 83713-0997
Phone: (208) 938-9912

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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