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General NPI Number Information
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NPI Number | 1144653833
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Entity Type | Organization
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Legal Business Name | PAMELA A. POWELL, DMD, PA
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 120 N 23RD ST
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City | BOISE
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State | ID
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Zip | 83702-4940
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Country | US
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Telephone | 208-344-2593
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Fax | 208-344-5208
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Provider Business Mailing Address
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Address Line | 120 N 23RD ST
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City | BOISE
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State | ID
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Zip | 83702-4940
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Country | US
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Telephone | 208-344-2593
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Fax | 208-344-5208
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. PAMELA A. POWELL
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Credential | DMD
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Telephone | 208-344-2593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D1819
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License Number State | ID
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