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Organization
NORTH END DENTAL PLLC
Active
Organization
NORTH END DENTAL PLLC
Active
Other names
North End Dental, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DOROTHY ANN MATTEFS (OFF MGR)
(208) 344-0134
Entity
Organization
Contact information
Practice address
704 N 17TH STREET, BOISE, ID 83702
(208) 344-0134
(208) 388-3990
Mailing address
704 N 17TH STREET, BOISE, ID 83702
(208) 344-0134
(208) 388-3990
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1933
ID
1223G0001X
General Practice Dentistry
D-3957
ID
1223G0001X
General Practice Dentistry
D1933
ID
1223G0001X
General Practice Dentistry
D4007
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000998900
—
ID
01
—
69948
BLUE CROSS
ID
05
—
807523400
—
ID
Enumeration date
08/30/2006
Last updated
12/11/2009
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