Provider Demographics
NPI:1477622983
Name:GORCZYCA, JAMES A (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:GORCZYCA
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 1:144 E MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3975
Mailing Address - Country:US
Mailing Address - Phone:208-342-0315
Mailing Address - Fax:
Practice Address - Street 1:144 E MALLARD DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3975
Practice Address - Country:US
Practice Address - Phone:208-342-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00001 0009341OtherREGENCE BLUE SHIELD
ID6E730OtherFEDERAL EMPLOYEE PROGRAM
ID66688OtherBLUE CROSS