| Boise Toothtown Dentistry For Kids Pllc | |
|
13014 W Persimmon Ln Boise ID 83713-1986 | |
| (208) 377-2072 | |
| (208) 376-7580 |
| Full Name | Boise Toothtown Dentistry For Kids Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 13014 W Persimmon Ln, Boise, Idaho |
| Authorized Official Name and Position | Dennis Garth Stoddard (OWNER) |
| Authorized Official Contact | 2084536188 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boise Toothtown Dentistry For Kids Pllc 13014 W Persimmon Ln Boise ID 83713-1986 Ph: (208) 377-2072 | Boise Toothtown Dentistry For Kids Pllc 13014 W Persimmon Ln Boise ID 83713-1986 Ph: (208) 377-2072 |
| NPI Number | 1780037705 |
|---|---|
| Provider Enumeration Date | 07/14/2016 |
| Last Update Date | 07/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780037705 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D4031 (Idaho) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | D4186PD (Idaho) | Primary |
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