Organization
BOISE PREMIER DENTISTRY
Active
Other names
Boise Premier Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MARYAM MOGHADDASIAN DDS (OWNER)
(208) 794-6391
Entity
Organization
Contact information
Practice address
3809 W STATE ST, BOISE, ID 83703-5221
(208) 551-5155
Mailing address
3809 W STATE ST, BOISE, ID 83703-5221
(208) 551-5155
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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