| Paventy Harrison Dental Llc | |
|
1675 W Hill Rd Boise ID 83702-0982 | |
| (509) 475-5367 | |
| Not Available |
| Full Name | Paventy Harrison Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1675 W Hill Rd, Boise, Idaho |
| Authorized Official Name and Position | Timothy Carl Paventy (OWNER) |
| Authorized Official Contact | 5094755367 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Paventy Harrison Dental Llc 1675 W Hill Rd Boise ID 83702-0982 Ph: (509) 475-5367 | Paventy Harrison Dental Llc 1675 W Hill Rd Boise ID 83702-0982 Ph: (509) 475-5367 |
| NPI Number | 1972014983 |
|---|---|
| Provider Enumeration Date | 10/17/2017 |
| Last Update Date | 10/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972014983 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D-4386 (Idaho) | Primary |
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