Organization
TROY A. CLOVIS DMD
Active
Other names
BENCHMARK FAMILY DENTISTRY
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUZANNE B MOONEY (BOOKKEEPER)
(208) 376-2726
Entity
Organization
Contact information
Practice address
4552 N CLOVERDALE RD, BOISE, ID 83713-2417
(208) 376-2726
(208) 376-6401
Mailing address
4552 N CLOVERDALE RD, BOISE, ID 83713-2417
(208) 376-2726
(208) 376-6401
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3039
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6100-2
BLUE CROSS OF IDAHO
ID
01
—
62644
UNITED CONCORDIA
ID
05
—
66D3039
—
ID
Enumeration date
06/03/2008
Last updated
06/03/2008
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