Individual
DR. GARY MICHAEL ALTENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
450 W STATE ST STE 115, EAGLE, ID 83616-7055
(208) 286-4200
(208) 286-4201
Mailing address
4940 N SOARING LN, EAGLE, ID 83616-1937
(760) 975-1657
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
46454
CA
1223E0200X
Endodontics
Primary
D-5078-EN
ID
Other
Enumeration date
05/16/2007
Last updated
07/07/2022
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