| Boise Children's Dentistry Pllc | |
|
136 E Mallard Dr Boise ID 83706-3975 | |
| (208) 500-5437 | |
| (208) 908-6178 |
| Full Name | Boise Children's Dentistry Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 136 E Mallard Dr, Boise, Idaho |
| Authorized Official Name and Position | Alexis Phillips Lyall (OWNER DENTIST) |
| Authorized Official Contact | 2085005437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boise Children's Dentistry Pllc 136 E Mallard Dr Boise ID 83706-3975 Ph: (208) 500-5437 | Boise Children's Dentistry Pllc 136 E Mallard Dr Boise ID 83706-3975 Ph: (208) 500-5437 |
| NPI Number | 1700503133 |
|---|---|
| Provider Enumeration Date | 10/26/2022 |
| Last Update Date | 10/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700503133 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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