Provider Demographics
NPI:1992117287
Name:ALL PHASES DENTISTRY PLLC
Entity type:Organization
Organization Name:ALL PHASES DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-695-5913
Mailing Address - Street 1:3810 N GARDEN CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5007
Mailing Address - Country:US
Mailing Address - Phone:208-853-5111
Mailing Address - Fax:208-853-5112
Practice Address - Street 1:3810 N GARDEN CENTER WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-5007
Practice Address - Country:US
Practice Address - Phone:208-853-5111
Practice Address - Fax:208-853-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD42001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty