# MALLARD FAMILY DENTAL CENTER, PLLC

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

## Provider details

- **NPI number:** 1740375591
- **Authorized official:** DR. JAMES A. GORCZYCA (OWNER)
- **Authorized official phone:** (208) 342-0315

## Contact information

- **Practice address:** 144 E MALLARD DR, BOISE, ID 83706-3975
- **Practice address phone:** (208) 342-0315
- **Mailing address:** 144 E MALLARD DR, BOISE, ID 83706-3975
- **Mailing address phone:** (208) 342-0315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1672 | ID | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00001 0135725 | REGENCE BLUE SHILD | ID |
| 01 | — | 66688 | BLUE CROSS | ID |
| 01 | — | 6E730 | FEDERAL EMPLOYEE PROVIDER | ID |
| 01 | — | 6E755 | FEDERAL EMPLOYEE PROVIDER | ID |