| Lake Harbor Dental | |
|
5355 W State St Boise ID 83703-3333 | |
| (208) 853-4687 | |
| (208) 853-4690 |
| Full Name | Lake Harbor Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5355 W State St, Boise, Idaho |
| Authorized Official Name and Position | Michael Eugene Peterson (PRESIDENT) |
| Authorized Official Contact | 2088534687 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Harbor Dental 5355 W State St Boise ID 83703-3333 Ph: (208) 853-4687 | Lake Harbor Dental 5355 W State St Boise ID 83703-3333 Ph: (208) 853-4687 |
| NPI Number | 1639310089 |
|---|---|
| Provider Enumeration Date | 03/16/2009 |
| Last Update Date | 03/16/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639310089 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D3044 (Idaho) | Primary |
| 1223G0001X | Dentist - General Practice | D4142 (Idaho) | Secondary |
Idaho Smiles Assoc. Plls Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 305 W Idaho St, Boise, ID 83702 Phone: 208-343-7271 | |
Treasure Valley Oral And Facial Surgery Pllc Dental Clinic Medicare: Medicare Enrolled Practice Location: 1000 N. Curtis Rd, Suite 103, Boise, ID 83706 Phone: 208-343-0909 Fax: 208-343-6282 | |
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Boise Smiles Youth Dentistry, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8744 Fairview Ave, Boise, ID 83704 Phone: 208-322-3010 Fax: 208-322-9273 | |
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