LAKE HARBOR DENTAL NPI 1639310089

NPI Information

LAKE HARBOR DENTAL is a general practice dentist in Boise, ID. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. LAKE HARBOR DENTAL NPI is 1639310089. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

5355 W STATE ST
BOISE, ID
ZIP 83703-333
Phone: (208) 853-4687
Fax: (208) 853-4690

The provider's authorized official is Michael Eugene Peterson .
The authorized official title is President and has the following contact phone number (208) 853-4687.

The enumeration date for this NPI number is 3/16/2009 and was last updated on 3/16/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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