Individual
DR. JACK H LINCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
140 E BOISE AVE, BOISE, ID 83706-4373
(208) 385-9228
Mailing address
4550 OREGON TRAIL PL, BOISE, ID 83716-5657
(808) 783-8368
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
4199
LA
1223P0300X
Periodontics
Primary
D-3947-PE
ID
Other
Enumeration date
12/01/2005
Last updated
07/08/2007
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