Provider Demographics
NPI:1033138235
Name:MESHACK-HART, ERNEST A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:A
Last Name:MESHACK-HART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0009
Mailing Address - Country:US
Mailing Address - Phone:208-467-4431
Mailing Address - Fax:208-466-5359
Practice Address - Street 1:2301 N 36TH ST STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-5202
Practice Address - Country:US
Practice Address - Phone:208-336-8801
Practice Address - Fax:208-466-5359
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-45431223G0001X
MTDEN-DEN-LIC-58791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice