Organization
MILLENNIUM FAMILY DENTAL - BOISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LYNN VIQUELIA (OFFICE MANAGER)
(208) 888-2026
Entity
Organization
Contact information
Practice address
813 STILSON RD, SUITE B, BOISE, ID 83703
(208) 342-4644
(208) 367-0283
Mailing address
1848 MILLENIUM WAY, MERIDIAN, ID 83642
(208) 888-2026
(208) 888-2094
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806766100
—
ID
Enumeration date
09/21/2006
Last updated
12/30/2014
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