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Organization
JON KOELTL DDS, PC
Active
Organization
JON KOELTL DDS, PC
Active
Other names
Centennial Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON MICHAEL KOELTL DDS (OWNER/DENTIST)
(208) 322-1112
Entity
Organization
Contact information
Practice address
12349 W MCMILLAN RD, BOISE, ID 83713-5052
(208) 322-1112
(208) 322-3928
Mailing address
12349 W MCMILLAN RD, BOISE, ID 83713-5052
(208) 322-1112
(208) 322-3928
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/29/2025
Last updated
04/29/2025
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