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Organization
NORTHWEST DENTAL CENTER, PA
Active
Organization
NORTHWEST DENTAL CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DON R COOK DDS (OWNER)
(208) 377-8078
Entity
Organization
Contact information
Practice address
8300 W NORTHVIEW ST, BOISE, ID 83704-7132
(208) 377-8078
(208) 377-3689
Mailing address
8300 W NORTHVIEW ST, BOISE, ID 83704-7132
(208) 377-8078
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3202
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
464827
UNITED CONCORDIA
ID
01
—
6C362
BLUE CROSS PROVIDER ID
ID
05
—
806376000
—
ID
Enumeration date
09/21/2006
Last updated
11/17/2022
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