Provider Demographics
NPI:1336340785
Name:BRUCE D.M.D. AND RIRIE D.D.S., P.A.
Entity Type:Organization
Organization Name:BRUCE D.M.D. AND RIRIE D.D.S., P.A.
Other - Org Name:BOISE INTEGRATIVE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:JUHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-336-0003
Mailing Address - Street 1:7878 W USTICK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5006
Mailing Address - Country:US
Mailing Address - Phone:208-376-2920
Mailing Address - Fax:208-376-8509
Practice Address - Street 1:7878 W USTICK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5006
Practice Address - Country:US
Practice Address - Phone:208-376-2920
Practice Address - Fax:208-376-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD16261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty