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Organization

BOISE TOWNE SQUARE DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RYAN LEE OLSON DDS (DR./OWNER)
(208) 639-4390
Entity
Organization

Contact information

Practice address
7677 W. EMERALD, BOISE, ID 83704
(208) 639-4390
(208) 639-4393
Mailing address
7677 W. EMERALD, BOISE, ID 83704
(208) 639-4390
(208) 639-4393

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4485
ID

Other

Enumeration date
06/18/2013
Last updated
06/18/2013
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