Organization
IDAHO ADVANCED DENTAL ANESTHESIA, LLC
Active
Organization
IDAHO ADVANCED DENTAL ANESTHESIA, LLC
Active
Other names
Idaho Dental Sedation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAKE WOOD DMD (OWNER)
(801) 369-8569
Entity
Organization
Contact information
Practice address
1310 S VISTA AVE STE 21, BOISE, ID 83705-2579
(208) 559-5518
Mailing address
1310 S VISTA AVE STE 21, BOISE, ID 83705-2579
(208) 559-5518
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
—
—
Other
Enumeration date
06/15/2026
Last updated
06/15/2026
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