LAKE HARBOR DENTAL PLLC NPI 1427669720

NPI Information

NPI: 1427669720
Provider Name: LAKE HARBOR DENTAL PLLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
5355 W STATE ST
BOISE, ID
ZIP 83703
Phone: (208) 853-4687
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LAKE HARBOR DENTAL PLLC is a dental clinic center in Boise, ID. LAKE HARBOR DENTAL PLLC NPI is 1427669720. The provider is registered as an organization entity type.

The provider's business location address is:

5355 W STATE ST
BOISE, ID
ZIP 83703-333
Phone: (208) 853-4687

The provider's authorized official is Eric Ballou .
The authorized official title is Owner and has the following contact phone number (208) 853-4687.

The enumeration date for this NPI number is 8/11/2020 and was last updated on 8/11/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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