Healthcare Provider Details

I. General information

NPI: 1316040975
Provider Name (Legal Business Name): LOUIS J BUHRLEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

742 W CHERRY LN
MERIDIAN ID
83642-1617
US

IV. Provider business mailing address

742 W CHERRY LN
MERIDIAN ID
83642-1617
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-1010
  • Fax: 208-888-4488
Mailing address:
  • Phone: 208-888-1010
  • Fax: 208-888-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD3331EN
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: