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Organization
EPP IDAHO PLLC
Active
Organization
EPP IDAHO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI GORLITZ (INSURANCE MANAGER)
(248) 505-9977
Entity
Organization
Contact information
Practice address
403 S 11TH ST STE 230, BOISE, ID 83702-6968
(208) 386-3636
Mailing address
5115 MARYLAND WAY STE 115, BRENTWOOD, TN 37027-7512
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
08/26/2021
Last updated
08/26/2021
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