Organization
IDAHO DENTAL PROFESSIONALS, P.C.
Active
Parent organization
HEARTLAND DENTAL
Other names
A Reason to Smile
Organization subpart
Yes
Provider details
NPI number
Legal business name
HEARTLAND DENTAL
Authorized official
TABATHA LEMKE (CREDENTIALING COORDINATOR)
(217) 540-6078
Entity
Organization
Contact information
Practice address
2803 N BOGUS BASIN RD, BOISE, ID 83702-0913
(208) 343-1393
Mailing address
2803 N BOGUS BASIN RD, BOISE, ID 83702-0913
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/11/2020
Last updated
09/11/2020
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