# DOWNTOWN DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073805735
- **Authorized official:** DR. RYAN MICHAEL KOWALCZYK (DENTIST)
- **Authorized official phone:** (208) 342-5444

## Contact information

- **Practice address:** 1625 W BANNOCK ST, BOISE, ID 83702-5155
- **Practice address phone:** (208) 342-5444
- **Practice address fax:** (208) 342-2076
- **Mailing address:** 1625 W BANNOCK ST, BOISE, ID 83702-5155
- **Mailing address phone:** (208) 342-5444
- **Mailing address fax:** (208) 342-2076

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-3689 | ID | Yes |

## Other

- **Enumeration date:** 05/12/2011
- **Last updated:** 05/12/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6P481 | BLUE CROSS OF IDAHO | ID |