Individual
PAMELA A. POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
120 N 23RD ST, BOISE, ID 83702-4940
(208) 344-2593
(208) 344-3993
Mailing address
120 N 23RD ST, BOISE, ID 83702-4940
(208) 344-2593
(208) 344-3993
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1819
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002763200
—
ID
Enumeration date
05/11/2007
Last updated
07/24/2008
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