# LYNN R. BLAISDELL, DDS, PA

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

## Provider details

- **NPI number:** 1881853208
- **Authorized official:** DR. LYNN R BLAISDELL DDS (PRESIDENT/OWNER)
- **Authorized official phone:** (208) 377-9696

## Contact information

- **Practice address:** 8877 W HACKAMORE DR, BOISE, ID 83709-1671
- **Practice address phone:** (208) 377-9696
- **Practice address fax:** (208) 377-9698
- **Mailing address:** 8877 W HACKAMORE DR, BOISE, ID 83709-1671
- **Mailing address phone:** (208) 377-9696
- **Mailing address fax:** (208) 377-9698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1697 | ID | Yes |

## Other

- **Enumeration date:** 06/02/2008
- **Last updated:** 06/02/2008