Organization
SPROUT PEDIATRIC DENTISTRY,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL MITCHELL (BUSINESS MANAGER)
(208) 467-5100
Entity
Organization
Contact information
Practice address
7800 W USTICK RD, BOISE, ID 83704-5848
(208) 576-6791
Mailing address
7800 W USTICK RD, BOISE, ID 83704-5848
(208) 576-6791
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
12/06/2021
Last updated
12/06/2021
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