Organization
TIMOTHY C. PAVENTY DMD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY C PAVENTY DMD (OWNER/DENTIST)
(208) 342-0315
Entity
Organization
Contact information
Practice address
144 E MALLARD DR, BOISE, ID 83706-3975
(208) 342-0873
Mailing address
144 E MALLARD DR, BOISE, ID 83706-3975
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4286
ID
Other
Enumeration date
03/13/2014
Last updated
03/13/2014
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