MEDICARE: DR. JONATHAN W PLUID D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D4675	ID

General Provider Information

NPI Number	:	1922480284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN W PLUID D.M.D

Provider Business Mailing Address
First Line	:	682 W LAUGHTON DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-6224
Country	:	US
Telephone Number	:	208-771-0495
Fax Number	:

Provider Business Practice Location Address
First Line	:	4274 N EAGLE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-0726
Country	:	US
Telephone Number	:	208-938-8228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2015
Last Update Date	:	06/23/2015

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