Individual
KRISTIN L FENWICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6657 N GLENWOOD ST, WATER'S EDGE DENTAL, BOISE, ID 83714
(208) 375-0572
(208) 375-1658
Mailing address
6657 N GLENWOOD ST, BOISE, ID 83714
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3159
ID
Other
Enumeration date
03/08/2007
Last updated
11/16/2015
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