Organization
LAKE HARBOR DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BALLOU (OWNER)
(208) 853-4687
Entity
Organization
Contact information
Practice address
5355 W STATE ST, BOISE, ID 83703-3333
(208) 853-4687
Mailing address
5355 W STATE ST, BOISE, ID 83703-3333
(208) 853-4687
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/11/2020
Last updated
08/11/2020
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