Individual
DR. BOONE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
527 RIGBY LAKE DR, SUITE B, RIGBY, ID 83442-1271
(208) 745-8704
(208) 745-7052
Mailing address
527 RIGBY LAKE DR., SUITE B, RIGBY, ID 83442
(208) 745-8704
(208) 745-7052
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3820
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6K356
BLUE CROSS OF IDAHO
ID
05
—
806947300
—
ID
Enumeration date
08/31/2006
Last updated
07/09/2007
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