| Wilson Dental Pllc | |
|
10497 W Garverdale Ct Ste 107 Boise ID 83704-5468 | |
| (208) 375-5720 | |
| (208) 323-8538 |
| Full Name | Wilson Dental Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 10497 W Garverdale Ct Ste 107, Boise, Idaho |
| Authorized Official Name and Position | Gregg Andrew Wilson (DENTIST/CEO) |
| Authorized Official Contact | 2089060501 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilson Dental Pllc 10497 W Garverdale Ct Ste 107 Boise ID 83704-5468 Ph: (208) 375-5720 | Wilson Dental Pllc 10497 W Garverdale Ct Ste 107 Boise ID 83704-5468 Ph: (208) 375-5720 |
| NPI Number | 1265935902 |
|---|---|
| Provider Enumeration Date | 03/08/2018 |
| Last Update Date | 03/08/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265935902 | NPI | - | NPPES |
| 807297400 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D35345 (Idaho) | Primary |
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