| Mallard Family Dental Center, Pllc | |
|
144 E Mallard Dr Boise ID 83706-3975 | |
| (208) 342-0315 | |
| Not Available |
| Full Name | Mallard Family Dental Center, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 144 E Mallard Dr, Boise, Idaho |
| Authorized Official Name and Position | James A. Gorczyca (OWNER) |
| Authorized Official Contact | 2083420315 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mallard Family Dental Center, Pllc 144 E Mallard Dr Boise ID 83706-3975 Ph: (208) 342-0315 | Mallard Family Dental Center, Pllc 144 E Mallard Dr Boise ID 83706-3975 Ph: (208) 342-0315 |
| NPI Number | 1740375591 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740375591 | NPI | - | NPPES |
| 00001 0135725 | Other | ID | REGENCE BLUE SHILD |
| 66688 | Other | ID | BLUE CROSS |
| 6E730 | Other | ID | FEDERAL EMPLOYEE PROVIDER |
| 6E755 | Other | ID | FEDERAL EMPLOYEE PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D1672 (Idaho) | Primary |
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