# DENTAL CARE WEST

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Basic Dental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508196189
- **Authorized official:** MR. CHARLES SCOTT GRACE DDS (DDS/ OWNER)
- **Authorized official phone:** (208) 342-7714

## Contact information

- **Practice address:** 850 S LATAH ST, BOISE, ID 83705-2255
- **Practice address phone:** (208) 342-7714
- **Practice address fax:** (208) 342-7781
- **Mailing address:** 850 S LATAH ST, BOISE, ID 83705-2255
- **Mailing address phone:** (208) 342-7714
- **Mailing address fax:** (208) 342-7781

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3522 | ID | Yes |

## Other

- **Enumeration date:** 01/05/2010
- **Last updated:** 01/05/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 807704900 | — | ID |
| 05 | — | 808491300 | — | ID |