Individual
DR. GREGORY JOHN BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9733 W USTICK RD, BOISE, ID 83704-5202
(208) 375-8720
(208) 375-8734
Mailing address
572 E KAIBAB TRAIL DR, MERIDIAN, ID 83646-3777
(208) 631-8244
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4300
ID
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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