Organization
PAVENTY HARRISON DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY CARL PAVENTY DDS (OWNER)
(509) 475-5367
Entity
Organization
Contact information
Practice address
1675 W HILL RD, BOISE, ID 83702-0982
(509) 475-5367
Mailing address
1675 W HILL RD, BOISE, ID 83702-0982
(509) 475-5367
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-4386
ID
Other
Enumeration date
10/17/2017
Last updated
10/17/2017
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