NPI 1033154604

Boise Smiles Youth Dentistry, PLLC

Organisation General Practice Dentistry Boise, ID

Practice location

Address: 8744 Fairview Ave, Boise, ID 83704-8207
Phone: (208) 322-3010
Fax: (208) 322-9273
Mailing address: 16 Arcade Unit 198747, Nashville, TN 37219-1994

Authorised official

Name: Jenell Stump
Title: Manager, Licensing & Credentialing
Phone: (615) 750-0343

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X

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Registry record

NPI: 1033154604
Entity type: Organization
NPI issued: 18 Jun 2006
Record last updated: 9 Jul 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.