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Organization

IDAHO DENTAL PROFESSIONALS, P.C.

Active
Parent organization
IDAHO DENTAL PROFESSIONALS, P.C.
Other names
Bristol Heights Dental
Organization subpart
Yes

Provider details

NPI number
Legal business name
IDAHO DENTAL PROFESSIONALS, P.C.
Authorized official
TABATHA LEMKE (CREDENTIALING COORDINATOR)
(217) 540-6078
Entity
Organization

Contact information

Practice address
6085 N EAGLE RD, BOISE, ID 83713-0997
(208) 938-9912
Mailing address
6085 N EAGLE RD, BOISE, ID 83713-0997
(208) 938-9912

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
03/23/2021
Last updated
03/23/2021
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