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General NPI Number Information
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NPI Number | 1346224458
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Entity Type | Individual
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Provider Name | JACK H LINCKS DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 140 E BOISE AVE
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City | BOISE
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State | ID
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Zip | 83706-4373
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Country | US
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Telephone | 208-385-9228
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Fax |
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Provider Business Mailing Address
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Address Line | 4550 OREGON TRAIL PL
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City | BOISE
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State | ID
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Zip | 83716-5657
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Country | US
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Telephone | 808-783-8368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 4199
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D-3947-PE
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License Number State | ID
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