NPI: 1770770026 · BOISE, ID 83704 · Dentist · NPI assigned 10/01/2007
| Authorized Official | SHELTON WAGERS, JILL (DENTIST) |
| NPI Enumeration Date | 10/01/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 12 | $705.54 |
| 2023 | 12 | $847.66 |
| 2024 | 12 | $1K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 36 | 36 | $3K |