Individual
MRS. JILL SHELTON WAGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
7235 EMERALD ST, SUITE B, BOISE, ID 83704-8600
(208) 376-7740
(208) 376-0468
Mailing address
7235 EMERALD ST, SUITE B, BOISE, ID 83704-8600
(208) 376-7740
(208) 376-0468
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3176
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6G595
BLUE CROSS
ID
Enumeration date
09/06/2006
Last updated
07/08/2007
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