Intermountain Dental Specialists

NPI 1134522535 - Clinic/Center - 261QD0000X

NPI Details
NPI 1134522535
Enumeration Date 09/30/2014
Last Updated 09/30/2014
Entity Type Healthcare Provider
Active Over 2 years ago
Authorized Information
Name JERRY MICHAEL JERRY
Position MANAGING MEMBER
Phone (208) 917-2855
Fax
Practice Location
12249 W MCMILLAN RD
BOISE ID, 83713-0555, US
Phone (208) 917-2855
Fax
Business Location
12249 W MCMILLAN RD
BOISE ID, 83713-0555, US
Phone (208) 917-2855
Fax
Toxanomy
Taxonomy Code 261QD0000X
License State Idaho
License Number D3642EN
Remove 1134522535 NPI Number
 

According to our database, Intermountain Dental Specialists NPI is 1134522535, taxonomy code is 261QD0000X and license number is D3642EN, license state is located at Idaho. Intermountain Dental Specialists physically located at 12249 W Mcmillan Rd, Boise ID, 83713-0555. NPI Number 1033115704 has the healthcare provider type.

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1134522535 NPI number is provided on an as is basis without warranty of any kind. 1134522535 is maintained by the National Plan & Provider Enumeration System. The contents of Intermountain Dental Specialists are for informational purposes only.