| Modern Dental | |
|
2031 E Hospitality Ln Suite 100 Boise ID 83716-6603 | |
| (208) 333-9999 | |
| (208) 343-5889 |
| Full Name | Modern Dental |
|---|---|
| Speciality | Dentist |
| Location | 2031 E Hospitality Ln, Boise, Idaho |
| Authorized Official Name and Position | Michelle D Ryan (OFFICE MANAGER) |
| Authorized Official Contact | 2083339999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Dental 2031 E Hospitality Ln Suite 100 Boise ID 83716-6603 Ph: (208) 333-9999 | Modern Dental 2031 E Hospitality Ln Suite 100 Boise ID 83716-6603 Ph: (208) 333-9999 |
| NPI Number | 1366601734 |
|---|---|
| Provider Enumeration Date | 06/02/2008 |
| Last Update Date | 09/06/2011 |
| Medicare PECOS PAC ID | 8022288034 |
|---|---|
| Medicare Enrollment ID | O20110831000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366601734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D3273 (Idaho) | Primary |
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