Provider Demographics
NPI:1073772281
Name:FENWICK AND HENRY LLP
Entity Type:Organization
Organization Name:FENWICK AND HENRY LLP
Other - Org Name:SYRINGA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:D'HULST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-375-0572
Mailing Address - Street 1:7800 USTICK RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5005
Mailing Address - Country:US
Mailing Address - Phone:208-375-0572
Mailing Address - Fax:
Practice Address - Street 1:7800 USTICK RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5005
Practice Address - Country:US
Practice Address - Phone:208-375-0572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental