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Individual

EDUARDO DOMINGUEZ LINO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RDH

Contact information

Practice address
2280 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3142
(208) 587-3988
Mailing address
5510 WEST TARGEE STREET, BOISE, ID 83705
(208) 906-6708

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH-3683
ID

Other

Enumeration date
10/16/2023
Last updated
10/16/2023
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