Organization
NORTH END DENTAL PLLC
Active
Other names
North End Dental, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DOROTHY ANN MATTEFS (OFF MGR)
(208) 344-0134
Entity
Organization
Contact information
Practice address
704 N 17TH STREET, BOISE, ID 83702
(208) 344-0134
(208) 388-3990
Mailing address
704 N 17TH STREET, BOISE, ID 83702
(208) 344-0134
(208) 388-3990
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1933
ID
1223G0001X
General Practice Dentistry
D-3957
ID
1223G0001X
General Practice Dentistry
D1933
ID
1223G0001X
General Practice Dentistry
D4007
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000998900
—
ID
01
—
69948
BLUE CROSS
ID
05
—
807523400
—
ID
Enumeration date
08/30/2006
Last updated
12/11/2009
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