| Dental Care West | |
|
850 S Latah St Boise ID 83705-2255 | |
| (208) 342-7714 | |
| (208) 342-7781 |
| Full Name | Dental Care West |
|---|---|
| Speciality | Dentist |
| Location | 850 S Latah St, Boise, Idaho |
| Authorized Official Name and Position | Charles Scott Grace (DDS/ OWNER) |
| Authorized Official Contact | 2083427714 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Care West 850 S Latah St Boise ID 83705-2255 Ph: (208) 342-7714 | Dental Care West 850 S Latah St Boise ID 83705-2255 Ph: (208) 342-7714 |
| NPI Number | 1508196189 |
|---|---|
| Provider Enumeration Date | 01/05/2010 |
| Last Update Date | 01/05/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508196189 | NPI | - | NPPES |
| 807704900 | Medicaid | ID | |
| 808491300 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D3522 (Idaho) | Primary |
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