Individual
DR. REBEKAH LEE GOFORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
620 W HAYS ST, BOISE, ID 83702-5511
(208) 297-6167
Mailing address
620 W HAYS ST, BOISE, ID 83702-5511
(828) 773-2251
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
16388
MD
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5261
ID
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
D-5261-OR
ID
Other
Enumeration date
04/26/2021
Last updated
04/02/2024
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