Idaho Dental Professionals, P.c.

NPI #1760162812 in Boise, Idaho

Provider Information

NPI Number: 1760162812
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: Jul 24, 2023
Last Updated: Jul 24, 2023

Practice Location

Address: 1578 S TIMESQUARE LN
City: Boise
State: Idaho
ZIP Code: 83709-8266
Phone: (208) 321-1141

Authorized Official

Name: CEMYIRA MCDOUGAL
Title: CREDENTIALING COORDINATOR
Phone: (217) 764-8609

Specialties & Taxonomy Codes

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

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