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General NPI Number Information
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NPI Number | 1962992552
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Entity Type | Organization
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Legal Business Name | FRANDSEN DENTAL
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 305 W IDAHO ST
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City | BOISE
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State | ID
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Zip | 83702-6040
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Country | US
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Telephone | 208-343-7271
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Fax |
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Provider Business Mailing Address
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Address Line | 305 W IDAHO ST
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City | BOISE
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State | ID
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Zip | 83702-6040
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Country | US
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Telephone | 208-343-7271
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUSTIN GREG FRANDSEN
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Credential | DDS
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Telephone | 208-821-0781
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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 | D-4838
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D-4223
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License Number State | ID
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