| Times Square Dental | |
|
1529 S Times Square Crt Boise ID 83709 | |
| (208) 343-1981 | |
| Not Available |
| Full Name | Times Square Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1529 S Times Square Crt, Boise, Idaho |
| Authorized Official Name and Position | Jon R Hastings (DENTIST) |
| Authorized Official Contact | 2083431981 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Times Square Dental 1529 S Times Square Crt Ste 100 Boise ID 83709 Ph: (208) 343-1981 | Times Square Dental 1529 S Times Square Crt Boise ID 83709 Ph: (208) 343-1981 |
| NPI Number | 1942469713 |
|---|---|
| Provider Enumeration Date | 06/05/2008 |
| Last Update Date | 06/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942469713 | NPI | - | NPPES |
| 804158500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D3254 (Idaho) | Primary |
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