# TMD PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Modern Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366601734
- **Authorized official:** MRS. MICHELLE D RYAN (OFFICE MANAGER)
- **Authorized official phone:** (208) 333-9999

## Contact information

- **Practice address:** 2031 E HOSPITALITY LN, SUITE 100, BOISE, ID 83716-6603
- **Practice address phone:** (208) 333-9999
- **Practice address fax:** (208) 343-5889
- **Mailing address:** 2031 E HOSPITALITY LN, SUITE 100, BOISE, ID 83716-6603
- **Mailing address phone:** (208) 333-9999
- **Mailing address fax:** (208) 343-5889

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3273 | ID | Yes |

## Other

- **Enumeration date:** 06/02/2008
- **Last updated:** 09/06/2011