Individual
CHARLES SCOTT GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
850 S LATAH ST, BOISE, ID 83705-2255
(208) 342-7714
(208) 342-7781
Mailing address
850 S LATAH ST, BOISE, ID 83705-2255
(208) 342-7714
(208) 342-7781
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3522
ID
Other
Enumeration date
05/07/2007
Last updated
08/02/2010
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