# BOISE BENCH DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Emerald Dental Associates PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770770026
- **Authorized official:** MRS. JILL SHELTON WAGERS DMD (DENTIST)
- **Authorized official phone:** (208) 327-0337

## Contact information

- **Practice address:** 7235 W EMERALD STREET, SUITE B, BOISE, ID 83704-8600
- **Practice address phone:** (208) 327-0337
- **Practice address fax:** (208) 376-0468
- **Mailing address:** 7235 W EMERALD STREET, SUITE B, BOISE, ID 83704-8600
- **Mailing address phone:** (208) 327-0337
- **Mailing address fax:** (208) 376-0468

## Taxonomy

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

## Other

- **Enumeration date:** 10/01/2007
- **Last updated:** 06/02/2021