Organization
LYNN R. BLAISDELL, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYNN R BLAISDELL DDS (PRESIDENT/OWNER)
(208) 377-9696
Entity
Organization
Contact information
Practice address
8877 W HACKAMORE DR, BOISE, ID 83709-1671
(208) 377-9696
(208) 377-9698
Mailing address
8877 W HACKAMORE DR, BOISE, ID 83709-1671
(208) 377-9696
(208) 377-9698
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1697
ID
Other
Enumeration date
06/02/2008
Last updated
06/02/2008
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