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NORTHWEST DENTAL CENTER

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Company Details

Name: NORTHWEST DENTAL CENTER
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 15 Dec 2017 (7 years ago)
Entity Number: 600162
Place of Formation: IDAHO
File Number: 0000600162
ZIP code: 83704
County: Ada County
Mailing Address: 8300 W NORTHVIEW ST BOISE, ID 83704

National Provider Identifier

NPI Number:
1922188333
Certification Date:
2022-11-17

Authorized Person:

Name:
DR. DON R COOK
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
No
Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
2083773689

Filing

Filing Name Filing Number Filing date
Initial Filing 0000600162 2017-12-15

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State