# TIMES SQUARE DENTAL

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

## Provider details

- **NPI number:** 1942469713
- **Authorized official:** DR. JON R HASTINGS DDS (DENTIST)
- **Authorized official phone:** (208) 343-1981

## Contact information

- **Practice address:** 1529 S TIMES SQUARE CRT, BOISE, ID 83709
- **Practice address phone:** (208) 343-1981
- **Mailing address:** 1529 S TIMES SQUARE CRT, STE 100, BOISE, ID 83709
- **Mailing address phone:** (208) 343-1981
- **Mailing address fax:** (208) 672-9067

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3254 | ID | Yes |

## Other

- **Enumeration date:** 06/05/2008
- **Last updated:** 06/05/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 804158500 | — | ID |