| Jason Champagne Idaho 5, Pllc | |
|
5993 W State St Ste B Boise ID 83703-5058 | |
| (208) 939-1700 | |
| Not Available |
| Full Name | Jason Champagne Idaho 5, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5993 W State St Ste B, Boise, Idaho |
| Authorized Official Name and Position | Jason Champagne (OWNER) |
| Authorized Official Contact | 7753593934 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jason Champagne Idaho 5, Pllc Po Box 2070 Sparks NV 89432-2070 Ph: () - | Jason Champagne Idaho 5, Pllc 5993 W State St Ste B Boise ID 83703-5058 Ph: (208) 939-1700 |
| NPI Number | 1114775640 |
|---|---|
| Provider Enumeration Date | 05/09/2024 |
| Last Update Date | 05/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114775640 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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