Individual
MR. JON RILEY HASTINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1529 S TIMESQUARE LN, BOISE, ID 83709-8266
(208) 343-1981
(208) 672-9067
Mailing address
1529 S. TIMES SQUARE CRT,, BOISE, ID 83709
(208) 343-1981
(208) 672-9067
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3254
IL
Other
Enumeration date
08/03/2006
Last updated
07/09/2007
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