Organization
TREASURE VALLEY PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLEEN A BEAUDRY D.M.D., M.S. (OWNER)
(208) 344-0908
Entity
Organization
Contact information
Practice address
813 N STILSON RD STE C, BOISE, ID 83703-5119
(208) 344-0908
Mailing address
813 N STILSON RD STE C, BOISE, ID 83703-5119
(208) 344-0908
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D-4444-PE
ID
Other
Enumeration date
12/17/2015
Last updated
12/17/2015
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