Organization
FRANDSEN DENTAL
Active
Other names
Idaho Street Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN GREG FRANDSEN DDS (OWNER)
(208) 821-0781
Entity
Organization
Contact information
Practice address
305 W IDAHO ST, BOISE, ID 83702-6040
(208) 343-7271
Mailing address
305 W IDAHO ST, BOISE, ID 83702-6040
(208) 343-7271
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-4223
ID
261QD0000X
Dental Clinic/Center
D-4838
ID
Other
Enumeration date
05/18/2018
Last updated
05/18/2018
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