# CHOICE DENTAL

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

## Provider details

- **NPI number:** 1255906277
- **Authorized official:** DR. TRENT M KELLY DDS (DENTIST)
- **Authorized official phone:** (208) 999-4746

## Contact information

- **Practice address:** 1991 W BROADWAY ST, IDAHO FALLS, ID 83402-3041
- **Practice address phone:** (208) 999-4746
- **Practice address fax:** (208) 357-4911
- **Mailing address:** 1991 W BROADWAY ST, IDAHO FALLS, ID 83402-3041
- **Mailing address phone:** (208) 999-4746
- **Mailing address fax:** (208) 357-4911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 124Q00000X | Dental Hygienist | — | NULL | — |
| 124Q00000X | Dental Hygienist | — | — | — |

## Other

- **Enumeration date:** 05/21/2021
- **Last updated:** 05/21/2021