Individual
DR. JUSTIN SCOTT MADSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2301 N 26TH ST STE 102, BOISE, ID 83702
(208) 336-8801
(208) 336-8682
Mailing address
2301 N 36TH ST STE 102, BOISE, ID 83702
(208) 336-8801
(208) 336-8682
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4572
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2013
Last updated
10/06/2014
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