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Organization

TIMES SQUARE DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JON R HASTINGS DDS (DENTIST)
(208) 343-1981
Entity
Organization

Contact information

Practice address
1529 S TIMES SQUARE CRT, BOISE, ID 83709
(208) 343-1981
Mailing address
1529 S TIMES SQUARE CRT, STE 100, BOISE, ID 83709
(208) 343-1981
(208) 672-9067

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3254
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
804158500
ID
Enumeration date
06/05/2008
Last updated
06/05/2008
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