# JONATHAN W BAUTER DDS

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

## Provider details

- **NPI number:** 1629449269
- **Authorized official:** DR. JONATHAN BAUTER DDS (OWNER)
- **Authorized official phone:** (208) 344-8363

## Contact information

- **Practice address:** 210 W MALLARD DR, SUITE E, BOISE, ID 83706-6642
- **Practice address phone:** (208) 344-8363
- **Mailing address:** 210 W MALLARD DR, SUITE E, BOISE, ID 83706-6642
- **Mailing address phone:** (208) 344-8363

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D4357 | ID | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |

## Other

- **Enumeration date:** 10/08/2015
- **Last updated:** 10/08/2015