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IDAHO PROSTHODONTICS

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Company Details

Name: IDAHO PROSTHODONTICS
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 21 Jun 2004 (21 years ago)
Entity Number: 242452
Place of Formation: IDAHO
File Number: 0000242452
ZIP code: 83712
County: Ada County
Mailing Address: 450 S GRANITE WAY BOISE, ID 83712

National Provider Identifier

NPI Number:
1275736522

Authorized Person:

Name:
DR. DARREL L MOONEY
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223P0700X - Prosthodontist
Is Primary:
Yes

Contacts:

Fax:
2082636786
Fax:
2083871951

Filing

Filing Name Filing Number Filing date
Initial Filing 0000242452 2004-06-21

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State