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Organization
TMD PLLC
Active
Organization
TMD PLLC
Active
Other names
Modern Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE D RYAN (OFFICE MANAGER)
(208) 333-9999
Entity
Organization
Contact information
Practice address
2031 E HOSPITALITY LN, SUITE 100, BOISE, ID 83716-6603
(208) 333-9999
(208) 343-5889
Mailing address
2031 E HOSPITALITY LN, SUITE 100, BOISE, ID 83716-6603
(208) 333-9999
(208) 343-5889
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3273
ID
Other
Enumeration date
06/02/2008
Last updated
09/06/2011
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