| Blair Pediatric Dentistry Pc | |
|
5360 N Eagle Rd Suite 103 Boise ID 83713-4901 | |
| (208) 938-9958 | |
| Not Available |
| Full Name | Blair Pediatric Dentistry Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5360 N Eagle Rd, Boise, Idaho |
| Authorized Official Name and Position | Randall P Blair (PRESIDENT) |
| Authorized Official Contact | 7024859804 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blair Pediatric Dentistry Pc 5360 N Eagle Rd Suite 103 Boise ID 83713-4901 Ph: (208) 938-9958 | Blair Pediatric Dentistry Pc 5360 N Eagle Rd Suite 103 Boise ID 83713-4901 Ph: (208) 938-9958 |
| NPI Number | 1629483987 |
|---|---|
| Provider Enumeration Date | 06/25/2014 |
| Last Update Date | 06/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629483987 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D4550PD (Idaho) | Primary |
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