Organization
HIDDEN CREEK DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HARVEY JAMES CLARK DDS (OWNER)
(208) 336-8478
Entity
Organization
Contact information
Practice address
580 W PARKCENTER BLVD, SUITE B, BOISE, ID 83706-3659
(208) 336-8478
Mailing address
580 W PARKCENTER BLVD, SUITE B, BOISE, ID 83706-3659
(208) 336-8478
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1699
ID
Other
Enumeration date
03/02/2017
Last updated
03/02/2017
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