# DENTISTRY ONE OF IDAHO PC

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

## Provider details

- **NPI number:** 1275314866
- **Authorized official:** BRANT HERMAN (CEO)
- **Authorized official phone:** (877) 712-7875

## Contact information

- **Practice address:** 800 W MAIN ST STE 1460, BOISE, ID 83702-5983
- **Practice address phone:** (877) 712-7875
- **Mailing address:** 20 HIGHLAND AVE, METUCHEN, NJ 08840-1949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | — |

## Other

- **Enumeration date:** 10/10/2023
- **Last updated:** 05/02/2025