# NORTHWEST DENTAL CENTER, PA

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

## Provider details

- **NPI number:** 1639278146
- **Authorized official:** DON R COOK DDS (OWNER)
- **Authorized official phone:** (208) 377-8078

## Contact information

- **Practice address:** 8300 W NORTHVIEW ST, BOISE, ID 83704-7132
- **Practice address phone:** (208) 377-8078
- **Practice address fax:** (208) 377-3689
- **Mailing address:** 8300 W NORTHVIEW ST, BOISE, ID 83704-7132
- **Mailing address phone:** (208) 377-8078

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3202 | ID | Yes |

## Other

- **Enumeration date:** 09/21/2006
- **Last updated:** 11/17/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 464827 | UNITED CONCORDIA | ID |
| 01 | — | 6C362 | BLUE CROSS PROVIDER ID | ID |
| 05 | — | 806376000 | — | ID |