| Intermountain Dental Specialists | |
|
12249 W Mcmillan Rd Boise ID 83713-0555 | |
| (208) 917-2855 | |
| Not Available |
| Full Name | Intermountain Dental Specialists |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12249 W Mcmillan Rd, Boise, Idaho |
| Authorized Official Name and Position | Jerry Michael Carbone (MANAGING MEMBER) |
| Authorized Official Contact | 2089172855 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intermountain Dental Specialists 12249 W Mcmillan Rd Boise ID 83713-0555 Ph: (208) 917-2855 | Intermountain Dental Specialists 12249 W Mcmillan Rd Boise ID 83713-0555 Ph: (208) 917-2855 |
| NPI Number | 1134522535 |
|---|---|
| Provider Enumeration Date | 09/30/2014 |
| Last Update Date | 09/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134522535 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D3642EN (Idaho) | Primary |
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