Lake Harbor Dental

NPI #1639310089 in Boise, Idaho

Provider Information

NPI Number: 1639310089
Entity Type: Organization
Organization Name: Lake Harbor Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 16, 2009
Last Updated: Mar 16, 2009

Practice Location

Address: 5355 W STATE ST
City: Boise
State: Idaho
ZIP Code: 83703-3333
Phone: (208) 853-4687

Authorized Official

Name: MR. MICHAEL EUGENE PETERSON, DDS, PA
Title: PRESIDENT
Phone: (208) 853-4687

Specialties & Taxonomy Codes

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

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