Organization
JAMES A. GORCZYCA DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY FANNIN (ACCOUNTS MANAGER)
(208) 342-0315
Entity
Organization
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
1223G0001X
General Practice Dentistry
Primary
D-1672
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002485600
—
ID
Enumeration date
06/10/2008
Last updated
06/10/2008
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