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General NPI Number Information
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NPI Number | 1679665822
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Entity Type | Organization
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Legal Business Name | DENTISTRY FOR CHILDREN
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 305 E JEFFERSON SUITE 103
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City | BOISE
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State | ID
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Zip | 83712
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Country | US
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Telephone | 208-384-9872
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Fax | 208-384-1801
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Provider Business Mailing Address
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Address Line | 305 E JEFFERSON SUITE 103
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City | BOISE
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State | ID
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Zip | 83712
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Country | US
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Telephone | 208-384-9872
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Fax | 208-384-1801
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. CHERYL A HIGER
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Credential | DMD
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Telephone | 208-384-9872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D3196PD
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License Number State | ID
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