Healthcare Provider Details

I. General information

NPI: 1245337625
Provider Name (Legal Business Name): ROBERT S. RIRIE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7878 W USTICK RD STE 101
BOISE ID
83704-5006
US

IV. Provider business mailing address

7878 W USTICK RD STE 101
BOISE ID
83704-5006
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-2920
  • Fax: 208-376-8509
Mailing address:
  • Phone: 208-376-2920
  • Fax: 208-376-8509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-3067
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: