# EPP IDAHO PLLC

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

## Provider details

- **NPI number:** 1144997149
- **Authorized official:** VICKI GORLITZ (INSURANCE MANAGER)
- **Authorized official phone:** (248) 505-9977

## Contact information

- **Practice address:** 403 S 11TH ST STE 230, BOISE, ID 83702-6968
- **Practice address phone:** (208) 386-3636
- **Mailing address:** 5115 MARYLAND WAY STE 115, BRENTWOOD, TN 37027-7512

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | — | Yes |

## Other

- **Enumeration date:** 08/26/2021
- **Last updated:** 08/26/2021