Individual
DANIEL JOHN STACKOWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1410 S ENTERTAINMENT AVE, BOISE, ID 83709-8306
(208) 321-4937
(208) 321-4834
Mailing address
1410 S ENTERTAINMENT AVE, BOISE, ID 83709-8306
(208) 321-4937
(208) 321-4834
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5162
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/21/2014
Last updated
12/11/2020
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