Individual
MALYNN RATTANASAMAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7800 W USTICK RD, BOISE, ID 83704-5848
(208) 576-6791
Mailing address
7800 W USTICK RD, BOISE, ID 83704-5848
(208) 576-6791
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7130
WI
1223G0001X
General Practice Dentistry
D-5505
ID
1223P0221X
Pediatric Dentistry
Primary
D-5505-PD
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740620731
—
WI
Enumeration date
07/05/2013
Last updated
05/13/2024
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