Rolf O Crichton, DDS

Individual provider Active NPI General Practice Dentistry · Boise, ID

NPI 1821158080 · NPPES record last updated Dec 3, 2007

Key facts

NPI
1821158080
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
D3879 (ID)
Practice address
10233 W Overland Rd
Boise, ID 83709-1430
Phone
(208) 323-4700
Fax
(208) 323-9409
NPI assigned
Dec 11, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
D3879IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
F. Alan Walker, DMD, PC Past Accepting new patients
South Boise Dentistry Co. Past
since Jan 15, 2023
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D3879 ID Yes

Addresses

Primary practice location

10233 W Overland Rd
Boise, ID 83709-1430

Mailing address

10233 W Overland Rd
Boise, ID 83709-1430
Phone (208) 323-4700

Other providers in Boise, ID

All providers in Boise, ID · General Practice Dentistry in Idaho

Sources for this page

Verify at the official NPI Registry.