Organization
CENTERPOINT ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J AGNETTA DDS,MS,PA (OWNER)
(208) 323-4800
Entity
Organization
Contact information
Practice address
5220 N EAGLE RD, BOISE, ID 83713-0945
(208) 323-4800
(208) 323-1299
Mailing address
5220 N EAGLE RD, BOISE, ID 83713-0945
(208) 323-4800
(208) 323-1299
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-1766-OR
ID
261QD0000X
Dental Clinic/Center
D-3856
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9201910
IDAHO SMILES/MILER
ID
05
—
9202027
—
ID
Enumeration date
01/07/2009
Last updated
01/07/2009
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