Provider Demographics
NPI:1275949281
Name:JAMES E PFOST DDS PA
Entity Type:Organization
Organization Name:JAMES E PFOST DDS PA
Other - Org Name:WEST VALLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:PFOST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-377-2223
Mailing Address - Street 1:9502 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8103
Mailing Address - Country:US
Mailing Address - Phone:208-377-2223
Mailing Address - Fax:208-672-0035
Practice Address - Street 1:9502 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8103
Practice Address - Country:US
Practice Address - Phone:208-377-2223
Practice Address - Fax:208-672-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD13651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty