# IDEAL DENTAL

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

## Provider details

- **NPI number:** 1073891461
- **Authorized official:** DR. TRAVIS BOYER (OWNER)
- **Authorized official phone:** (208) 459-3388

## Contact information

- **Practice address:** 329 E LOGAN ST, CALDWELL, ID 83605-4863
- **Practice address phone:** (208) 459-3388
- **Practice address fax:** (208) 453-9295
- **Mailing address:** 329 E LOGAN ST, CALDWELL, ID 83605-4863
- **Mailing address phone:** (208) 459-3388
- **Mailing address fax:** (208) 453-9295

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3896 | ID | Yes |

## Other

- **Enumeration date:** 08/02/2011
- **Last updated:** 08/02/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1194808238 | NPI | ID |
| 01 | — | 1992715304 | NPI | ID |