Provider Demographics
NPI:1346224458
Name:LINCKS, JACK H (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:H
Last Name:LINCKS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 OREGON TRAIL PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5657
Mailing Address - Country:US
Mailing Address - Phone:808-783-8368
Mailing Address - Fax:
Practice Address - Street 1:140 E BOISE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-4373
Practice Address - Country:US
Practice Address - Phone:208-385-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41991223P0300X
IDD-3947-PE1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics