Healthcare Provider Details

I. General information

NPI: 1003853904
Provider Name (Legal Business Name): ERROL CHANDLER FIFE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 HILL RD
BOISE ID
83702-0982
US

IV. Provider business mailing address

1675 HILL RD
BOISE ID
83702-0982
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-3695
  • Fax: 208-342-4065
Mailing address:
  • Phone: 208-342-3695
  • Fax: 208-342-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-1587
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: