| Centerpoint Orthodontics | |
|
5220 N Eagle Rd Boise ID 83713-0945 | |
| (208) 323-4800 | |
| (208) 323-1299 |
| Full Name | Centerpoint Orthodontics |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5220 N Eagle Rd, Boise, Idaho |
| Authorized Official Name and Position | Robert J Agnetta (OWNER) |
| Authorized Official Contact | 2083234800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centerpoint Orthodontics 5220 N Eagle Rd Boise ID 83713-0945 Ph: (208) 323-4800 | Centerpoint Orthodontics 5220 N Eagle Rd Boise ID 83713-0945 Ph: (208) 323-4800 |
| NPI Number | 1073750469 |
|---|---|
| Provider Enumeration Date | 01/07/2009 |
| Last Update Date | 01/07/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073750469 | NPI | - | NPPES |
| 9201910 | Other | ID | IDAHO SMILES/MILER |
| 9202027 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D-1766-OR (Idaho) | Primary |
| 261QD0000X | Clinic/center - Dental | D-3856 (Idaho) | Secondary |
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