| Boise Orthodontics P.a. | |
|
4725 N Cloverdale Rd Suite 101 Boise ID 83713-4911 | |
| (208) 323-4458 | |
| Not Available |
| Full Name | Boise Orthodontics P.a. |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 4725 N Cloverdale Rd, Boise, Idaho |
| Authorized Official Name and Position | Glen Allen Smith (OWNER) |
| Authorized Official Contact | 2083234458 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boise Orthodontics P.a. 4725 N Cloverdale Rd Suite 101 Boise ID 83713-4911 Ph: (208) 323-4458 | Boise Orthodontics P.a. 4725 N Cloverdale Rd Suite 101 Boise ID 83713-4911 Ph: (208) 323-4458 |
| NPI Number | 1770754186 |
|---|---|
| Provider Enumeration Date | 03/13/2008 |
| Last Update Date | 03/13/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770754186 | NPI | - | NPPES |
| 6L271 | Other | ID | BLUE CROSS ID |
| 734506 | Other | ID | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | D-3036-OR (Idaho) | Primary |
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