Provider Demographics
NPI:1962568782
Name:DENTAL PARTNERS, PLLC
Entity type:Organization
Organization Name:DENTAL PARTNERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-466-8400
Mailing Address - Street 1:203 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3846
Mailing Address - Country:US
Mailing Address - Phone:208-466-8400
Mailing Address - Fax:208-466-8436
Practice Address - Street 1:203 7TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3846
Practice Address - Country:US
Practice Address - Phone:208-466-8400
Practice Address - Fax:208-466-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD36101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010143908OtherBLUE SHIELD OF ID
ID806628200Medicaid
PA01478887OtherUNITED CONCORDIA
ID6H361OtherBLUE CROSS