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Organization
JASON CHAMPAGNE IDAHO 1, PLLC
Active
Organization
JASON CHAMPAGNE IDAHO 1, PLLC
Active
Other names
Emerald West Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
JASON CHAMPAGNE DDS (OWNER)
(775) 359-3934
Entity
Organization
Contact information
Practice address
8850 W EMERALD ST STE 150, BOISE, ID 83704-4809
(208) 323-2294
Mailing address
PO BOX 2070, SPARKS, NV 89432-2070
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/09/2024
Last updated
05/09/2024
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