Organization
SILVER LAKE DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES S HOUGH DDS (OWNER)
(208) 762-3027
Entity
Organization
Contact information
Practice address
6176 N GOVERNMENT WAY, DALTON GARDENS, ID 83815-7331
(208) 762-3027
(208) 762-0531
Mailing address
6176 N GOVERNMENT WAY, DALTON GARDENS, ID 83815-7331
(208) 762-3027
(208) 762-0531
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3104
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1223G0001X
GENERAL PRACTICE DENTIST
ID
Enumeration date
06/10/2008
Last updated
06/10/2008
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