Healthcare Provider Details

I. General information

NPI: 1598154981
Provider Name (Legal Business Name): HORIZON 1 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N CURTIS RD STE 103
BOISE ID
83706-1345
US

IV. Provider business mailing address

1000 N CURTIS RD STE 103
BOISE ID
83706-1345
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-0909
  • Fax: 208-343-6282
Mailing address:
  • Phone: 208-343-0909
  • Fax: 208-343-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD4410OS
License Number StateID

VIII. Authorized Official

Name: DR. COLE W ANDERSON
Title or Position: CEO
Credential: DMD, MS
Phone: 208-343-0909