Organization
BRADEN M. STAUTS DDS LLC
Active
Other names
Braden Stauts DDS
Organization subpart
No
Provider details
NPI number
Authorized official
BRADEN M STAUTS DDS (OWNER)
(208) 376-0567
Entity
Organization
Contact information
Practice address
1000 N CURTIS RD, SUITE 203, BOISE, ID 83706-1337
(208) 376-0567
Mailing address
1000 N CURTIS RD, SUITE 203, BOISE, ID 83706-1337
(208) 376-0567
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-2083-PR
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578588364
PERSONAL NPI
ID
Enumeration date
11/24/2008
Last updated
11/24/2008
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