Modern Dental | |
2031 E Hospitality Ln Suite 100 Boise ID 83716-6603 | |
(208) 333-9999 | |
(208) 343-5889 |
Full Name | Modern Dental |
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Speciality | Dentist |
Location | 2031 E Hospitality Ln, Boise, Idaho |
Authorized Official Name and Position | Michelle D Ryan (OFFICE MANAGER) |
Authorized Official Contact | 2083339999 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Modern Dental 2031 E Hospitality Ln Suite 100 Boise ID 83716-6603 Ph: (208) 333-9999 | Modern Dental 2031 E Hospitality Ln Suite 100 Boise ID 83716-6603 Ph: (208) 333-9999 |
NPI Number | 1366601734 |
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Provider Enumeration Date | 06/02/2008 |
Last Update Date | 09/06/2011 |
Medicare PECOS PAC ID | 8022288034 |
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Medicare Enrollment ID | O20110831000186 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366601734 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | D3273 (Idaho) | Primary |
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