# NORTH END DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** North End Dental, PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902916018
- **Authorized official:** MRS. DOROTHY ANN MATTEFS (OFF MGR)
- **Authorized official phone:** (208) 344-0134

## Contact information

- **Practice address:** 704 N 17TH STREET, BOISE, ID 83702
- **Practice address phone:** (208) 344-0134
- **Practice address fax:** (208) 388-3990
- **Mailing address:** 704 N 17TH STREET, BOISE, ID 83702
- **Mailing address phone:** (208) 344-0134
- **Mailing address fax:** (208) 388-3990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-1933 | ID | Yes |
| 1223G0001X | General Practice Dentistry | D-3957 | ID | — |
| 1223G0001X | General Practice Dentistry | D1933 | ID | — |
| 1223G0001X | General Practice Dentistry | D4007 | ID | — |

## Other

- **Enumeration date:** 08/30/2006
- **Last updated:** 12/11/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000998900 | — | ID |
| 01 | — | 69948 | BLUE CROSS | ID |
| 05 | — | 807523400 | — | ID |