| Pediatric Dentistry Associates | |
|
13014 W Persimmon Ln Boise ID 83713-1986 | |
| (208) 377-2072 | |
| Not Available |
| Full Name | Pediatric Dentistry Associates |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 13014 W Persimmon Ln, Boise, Idaho |
| Authorized Official Name and Position | Rodman O Emory (PRESIDENT/PEDIATRIC DENTIST) |
| Authorized Official Contact | 2083772072 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry Associates 13014 W Persimmon Ln Boise ID 83713-1986 Ph: (208) 377-2072 | Pediatric Dentistry Associates 13014 W Persimmon Ln Boise ID 83713-1986 Ph: (208) 377-2072 |
| NPI Number | 1851627467 |
|---|---|
| Provider Enumeration Date | 11/02/2009 |
| Last Update Date | 11/02/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851627467 | NPI | - | NPPES |
| 002697900 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D-1703 (Idaho) | Primary |
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