Individual
DR. JERRY MICHAEL CARBONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
12249 W MCMILLAN RD, BOISE, ID 83713-0555
(208) 917-2855
(208) 258-7553
Mailing address
12249 W MCMILLAN RD, BOISE, ID 83713-0555
(208) 917-2855
(208) 258-7553
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D-3642EN
ID
Other
Enumeration date
08/17/2006
Last updated
10/01/2014
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