# SOUTHWEST DENTAL ASSOCIATES

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

## Provider details

- **NPI number:** 1124346499
- **Authorized official:** DR. JEFFREY TULLER DDS (DENTIST)
- **Authorized official phone:** (208) 322-5655

## Contact information

- **Practice address:** 1201 S FIVE MILE RD, BOISE, ID 83709-1304
- **Practice address phone:** (208) 322-5655
- **Practice address fax:** (208) 323-8160
- **Mailing address:** 1201 S FIVE MILE RD, BOISE, ID 83709-1304
- **Mailing address phone:** (208) 322-5655
- **Mailing address fax:** (208) 323-8160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D2065 | ID | Yes |

## Other

- **Enumeration date:** 05/12/2010
- **Last updated:** 05/12/2010