Healthcare Provider Details

I. General information

NPI: 1457354466
Provider Name (Legal Business Name): A RILEY CUTLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13108 W PERSIMMON LN
BOISE ID
83713-1986
US

IV. Provider business mailing address

13108 W PERSIMMON LN
BOISE ID
83713-1986
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-0524
  • Fax: 208-376-6440
Mailing address:
  • Phone: 208-375-0524
  • Fax: 208-376-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD1476
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: