| Northwest Dental Center, Pa | |
|
8300 W Northview St Boise ID 83704-7132 | |
| (208) 377-8078 | |
| (208) 377-3689 |
| Full Name | Northwest Dental Center, Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8300 W Northview St, Boise, Idaho |
| Authorized Official Name and Position | Don R Cook (OWNER) |
| Authorized Official Contact | 2083778078 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Dental Center, Pa 8300 W Northview St Boise ID 83704-7132 Ph: (208) 377-8078 | Northwest Dental Center, Pa 8300 W Northview St Boise ID 83704-7132 Ph: (208) 377-8078 |
| NPI Number | 1639278146 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 11/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639278146 | NPI | - | NPPES |
| 464827 | Other | ID | UNITED CONCORDIA |
| 6C362 | Other | ID | BLUE CROSS PROVIDER ID |
| 806376000 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D3202 (Idaho) | Primary |
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