Individual
DR. JOEL R BINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
801 S RISING SUN DR, NAMPA, ID 83686-6009
(208) 466-6161
(208) 298-0633
Mailing address
11390 W SHAY PARK DR, NAMPA, ID 83686-8028
(208) 461-3228
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3801
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010012520
BLUE SHIELD OF IDAHO #
ID
01
—
632043
UNITED CONCORDIA PROVIDER
—
01
—
6K141
BLUE CROSS OF ID PROVIDER
ID
05
—
807473900
—
ID
Enumeration date
08/12/2006
Last updated
08/07/2014
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