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Night Boat Pllc
Pediatric Dentist in Rexburg, Idaho
NPI 1013188804

Night Boat Pllc is a Pediatric Dentist based in Rexburg, ID and is specialized in Pediatric Dentistry. Night Boat Pllc practices in Rexburg, ID. The NPI Number for Night Boat Pllc is 1013188804 and holds a License No. (Idaho).

The current practice location address for Night Boat Pllc is 859 S Yellowstone Hwy Ste 1202, Rexburg, ID and can be reached out via phone at 208-552-5439 and via fax at 208-552-5440.

Location: 859 S Yellowstone Hwy Ste 1202, Rexburg, ID, 83440-6201
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1013188804
Provider Name
Night Boat Pllc
Credential
Provider Entity Type
Organization
Address
859 S Yellowstone Hwy Ste 1202, Rexburg, ID, 83440-6201
Phone Number
208-552-5439
Fax Number
208-552-5440
Provider Enumeration Date
03/19/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
807793700 05 ID
6P475 01 ID BLUECROSS OF IDAHO
9202516 01 MEDICAID - IDAHO SMILES
000010165079 01 ID REGENCE BLUESHIELD OF ID
institution
Provider Business Practice Location Address Details
Address
859 S Yellowstone Hwy Ste 1202
City
Rexburg
State
Idaho
Zip
83440-6201
Phone Number
208-552-5439
Fax Number
208-552-5440
person
Provider Business Mailing Address Details
Address
859 S Yellowstone Hwy Ste 1202
City
Rexburg
State
Idaho
Zip
83440-6201
Phone Number
208-552-5439
Fax Number
208-552-5440
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
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Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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