Provider Demographics
NPI:1790808012
Name:CENTER FOR CONTEMPORARY DENTISTRY
Entity Type:Organization
Organization Name:CENTER FOR CONTEMPORARY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAYSON
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-342-8000
Mailing Address - Street 1:3157 SO BOWN WAY
Mailing Address - Street 2:STE 200
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706
Mailing Address - Country:US
Mailing Address - Phone:208-342-8000
Mailing Address - Fax:208-342-8011
Practice Address - Street 1:3157 SO BOWN WAY
Practice Address - Street 2:STE 200
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-342-8000
Practice Address - Fax:208-342-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty