| NPI | 1447305610 |
|---|---|
| Doing Business As | HERITAGE HEALTH DENTAL |
| Entity Type | Organization |
| Authorized Contact | MIKE BAKER CEO 208-620-5200 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2023-08-24 |