| Millennium Family Dental - Boise Llc | |
|
813 Stilson Rd Suite B Boise ID 83703 | |
| (208) 342-4644 | |
| (208) 367-0283 |
| Full Name | Millennium Family Dental - Boise Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 813 Stilson Rd, Boise, Idaho |
| Authorized Official Name and Position | Jennifer Lynn Viquelia (OFFICE MANAGER) |
| Authorized Official Contact | 2088882026 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Millennium Family Dental - Boise Llc 1848 Millenium Way Meridian ID 83642 Ph: (208) 888-2026 | Millennium Family Dental - Boise Llc 813 Stilson Rd Suite B Boise ID 83703 Ph: (208) 342-4644 |
| NPI Number | 1104925064 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 12/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104925064 | NPI | - | NPPES |
| 806766100 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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