Dental Care West

NPI #1508196189 in Boise, Idaho

Provider Information

NPI Number: 1508196189
Entity Type: Organization
Organization Name: Dental Care West
Primary Specialty: Dentist
Enumeration Date: Jan 5, 2010
Last Updated: Jan 5, 2010

Practice Location

Address: 850 S LATAH ST
City: Boise
State: Idaho
ZIP Code: 83705-2255
Phone: (208) 342-7714

Authorized Official

Name: MR. CHARLES SCOTT GRACE, DDS
Title: DDS/ OWNER
Phone: (208) 342-7714

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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