Full Name | Ideal Dental |
---|---|
Speciality | Dentist - General Practice |
Location | 329 E Logan St, Caldwell, Idaho |
Authorized Official Name and Position | Travis Boyer (OWNER) |
Authorized Official Contact | 2084593388 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Ideal Dental 329 E Logan St Caldwell ID 83605-4863 Ph: (208) 459-3388 | Ideal Dental 329 E Logan St Caldwell ID 83605-4863 Ph: (208) 459-3388 |
NPI Number | 1073891461 |
---|---|
Provider Enumeration Date | 08/02/2011 |
Last Update Date | 08/02/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073891461 | NPI | - | NPPES |
1194808238 | Other | ID | NPI |
1992715304 | Other | ID | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | D3896 (Idaho) | Primary |
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