Organization
DENTAL CARE WEST
Active
Other names
Basic Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SCOTT GRACE DDS (DDS/ OWNER)
(208) 342-7714
Entity
Organization
Contact information
Practice address
850 S LATAH ST, BOISE, ID 83705-2255
(208) 342-7714
(208) 342-7781
Mailing address
850 S LATAH ST, BOISE, ID 83705-2255
(208) 342-7714
(208) 342-7781
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3522
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807704900
—
ID
05
—
808491300
—
ID
Enumeration date
01/05/2010
Last updated
01/05/2010
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