Provider Demographics
NPI:1043060494
Name:AFFORDABLE DENTURES & IMPLANTS - IDAHO II, PLLC
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - IDAHO II, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-321-4937
Mailing Address - Street 1:1410 S ENTERTAINMENT AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-8306
Mailing Address - Country:US
Mailing Address - Phone:208-321-4937
Mailing Address - Fax:
Practice Address - Street 1:1410 S ENTERTAINMENT AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-8306
Practice Address - Country:US
Practice Address - Phone:208-321-4937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty