# BOISE TOWNE SQUARE DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104026822
- **Authorized official:** DR. WADE PILLING D.M.D (OWNER)
- **Authorized official phone:** (208) 888-0662

## Contact information

- **Practice address:** 7677 W EMERALD ST, BOISE, ID 83704-9018
- **Practice address phone:** (208) 888-0662
- **Practice address fax:** (208) 888-0863
- **Mailing address:** 7677 W EMERALD ST, BOISE, ID 83704-9018
- **Mailing address phone:** (208) 888-0662
- **Mailing address fax:** (208) 888-0863

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3877 | ID | Yes |

## Other

- **Enumeration date:** 07/20/2007
- **Last updated:** 07/20/2007