# MATTHEW G. FETHKE, D.D.S.,PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** High Desert Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841450889
- **Authorized official:** JANET D HEFNER (OFFICE MANAGER)
- **Authorized official phone:** (208) 343-4732

## Contact information

- **Practice address:** 12212 W AMITY RD, BOISE, ID 83709-5389
- **Practice address phone:** (208) 343-4732
- **Practice address fax:** (208) 343-3818
- **Mailing address:** 12212 W AMITY RD, BOISE, ID 83709-5389
- **Mailing address phone:** (208) 343-4732
- **Mailing address fax:** (208) 343-3818

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3413 | ID | Yes |

## Other

- **Enumeration date:** 06/12/2008
- **Last updated:** 06/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1447343488 | NPI | ID |