# BOISE PREMIER DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Boise Premier Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689258758
- **Authorized official:** MARYAM MOGHADDASIAN DDS (OWNER)
- **Authorized official phone:** (208) 794-6391

## Contact information

- **Practice address:** 3809 W STATE ST, BOISE, ID 83703-5221
- **Practice address phone:** (208) 551-5155
- **Mailing address:** 3809 W STATE ST, BOISE, ID 83703-5221
- **Mailing address phone:** (208) 551-5155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 05/05/2021
- **Last updated:** 05/05/2021