Organization
TREE CITY FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUSTIN CONNAUGHTON DDS (DENTIST/OWNER)
(208) 286-2699
Entity
Organization
Contact information
Practice address
7301 W. EMERALD ST STE. 102, BOISE, ID 83704
(208) 286-2699
(208) 350-6526
Mailing address
7301 W. EMERALD ST STE. 102, BOISE, ID 83704
(208) 286-2699
(208) 350-6526
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9200495
—
ID
Enumeration date
07/24/2020
Last updated
07/24/2020
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