# BLUESKY DENTAL

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

## Provider details

- **NPI number:** 1073808333
- **Authorized official:** DR. KEVIN C HENRY DDS (OWNER)
- **Authorized official phone:** (208) 882-9111

## Contact information

- **Practice address:** 2500 W A ST STE 204, MOSCOW, ID 83843-6000
- **Practice address phone:** (208) 882-9111
- **Practice address fax:** (208) 882-3279
- **Mailing address:** 2500 W A ST STE 204, MOSCOW, ID 83843-6000
- **Mailing address phone:** (208) 882-9111
- **Mailing address fax:** (208) 882-3279

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3597 | ID | Yes |

## Other

- **Enumeration date:** 06/15/2011
- **Last updated:** 06/15/2011