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General NPI Number Information
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NPI Number | 1013831775
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Entity Type | Organization
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Legal Business Name | TIMES SQUARE DENTAL
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 1529 S TIMESQUARE LN
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City | BOISE
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State | ID
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Zip | 83709-8266
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Country | US
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Telephone | 208-343-1981
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 S TIMESQUARE LN
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City | BOISE
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State | ID
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Zip | 83709-8266
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Country | US
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Telephone | 208-343-1981
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. GINA NETTLES
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Credential |
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Telephone | 208-989-3727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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