| Trista E Pottenger, Dmd Pllc | |
|
12212 W Amity Rd Boise ID 83709-5389 | |
| (208) 343-4732 | |
| (208) 343-3818 |
| Full Name | Trista E Pottenger, Dmd Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12212 W Amity Rd, Boise, Idaho |
| Authorized Official Name and Position | Trista E Pottenger (OWNER) |
| Authorized Official Contact | 2084848212 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Trista E Pottenger, Dmd Pllc 12212 W Amity Rd Boise ID 83709-5389 Ph: (208) 343-4732 | Trista E Pottenger, Dmd Pllc 12212 W Amity Rd Boise ID 83709-5389 Ph: (208) 343-4732 |
| NPI Number | 1649935818 |
|---|---|
| Provider Enumeration Date | 11/03/2021 |
| Last Update Date | 11/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649935818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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