Organization
HIDDEN CREEK DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN JAMES CLARK DDS (SOLE OWNER/DENTIST)
(208) 336-8478
Entity
Organization
Contact information
Practice address
580 W PARKCENTER BLVD, BOISE, ID 83706-3659
(208) 336-8478
Mailing address
580 W PARKCENTER BLVD, BOISE, ID 83706-3659
(208) 336-8478
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/31/2024
Last updated
12/31/2024
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