Healthcare Provider Details

I. General information

NPI: 1295661544
Provider Name (Legal Business Name): MARNIE LEIGH VONDERHAAR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 N MITCHELL ST
BOISE ID
83704-4863
US

IV. Provider business mailing address

607 N MITCHELL ST
BOISE ID
83704-4863
US

V. Phone/Fax

Practice location:
  • Phone: 855-433-6825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3781111
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: