INTERMOUNTAIN DENTAL SPECIALISTS NPI 1134522535

NPI Information

NPI: 1134522535
Provider Name: INTERMOUNTAIN DENTAL SPECIALISTS
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
12249 W MCMILLAN RD
BOISE, ID
ZIP 83713
Phone: (208) 917-2855
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INTERMOUNTAIN DENTAL SPECIALISTS is a dental clinic center in Boise, ID. INTERMOUNTAIN DENTAL SPECIALISTS NPI is 1134522535. The provider is registered as an organization entity type.

The provider's business location address is:

12249 W MCMILLAN RD
BOISE, ID
ZIP 83713-555
Phone: (208) 917-2855

The provider's authorized official is Jerry Michael Carbone .
The authorized official title is Managing Member and has the following contact phone number (208) 917-2855.

The enumeration date for this NPI number is 9/30/2014 and was last updated on 9/30/2014.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	D3642EN	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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