Organization Name: | NIGHT BOAT PLLC |
NPI Number: | 1013188804 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROSS N HUGUES (OWNER/PEDIATRIC DENTIST) |
Mailing Address: | 859 S Yellowstone Hwy Ste 1202 Rexburg |
State: | ID US |
Postal Code: | 834406201 |
Phone Number: | 2085525439 |
Fax Number: | 2085525440 |
NPI Enumeration Date: | 03/19/2008 |
NPI Last Update Date: | 02/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy 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. |