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Organization
FACIAL TRAUMA ASSOCIATES PLLC
Active
Organization
FACIAL TRAUMA ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COLE W ANDERSON DMD (MEMBER)
(208) 343-0909
Entity
Organization
Contact information
Practice address
1000 N CURTIS RD STE 103, BOISE, ID 83706-1345
(208) 343-0909
Mailing address
1000 N CURTIS RD STE 103, BOISE, ID 83706-1345
(208) 343-0909
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
02/14/2020
Last updated
02/14/2020
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