Individual
JAMES A GORCZYCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
144 E MALLARD DR, BOISE, ID 83706-3975
(208) 342-0315
Mailing address
144 E MALLARD DR, BOISE, ID 83706-3975
(208) 342-0315
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1672
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001 0009341
REGENCE BLUE SHIELD
ID
01
—
66688
BLUE CROSS
ID
01
—
6E730
FEDERAL EMPLOYEE PROGRAM
ID
Enumeration date
11/07/2006
Last updated
07/09/2007
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