Organization
MATTHEW G. FETHKE, D.D.S.,PC
Active
Other names
High Desert Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JANET D HEFNER (OFFICE MANAGER)
(208) 343-4732
Entity
Organization
Contact information
Practice address
12212 W AMITY RD, BOISE, ID 83709-5389
(208) 343-4732
(208) 343-3818
Mailing address
12212 W AMITY RD, BOISE, ID 83709-5389
(208) 343-4732
(208) 343-3818
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3413
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447343488
NPI
ID
Enumeration date
06/12/2008
Last updated
06/12/2008
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