# TIMOTHY C. PAVENTY DMD, LLC

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

## Provider details

- **NPI number:** 1649696741
- **Authorized official:** TIMOTHY C PAVENTY DMD (OWNER/DENTIST)
- **Authorized official phone:** (208) 342-0315

## Contact information

- **Practice address:** 144 E MALLARD DR, BOISE, ID 83706-3975
- **Practice address phone:** (208) 342-0873
- **Mailing address:** 144 E MALLARD DR, BOISE, ID 83706-3975

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-4286 | ID | Yes |

## Other

- **Enumeration date:** 03/13/2014
- **Last updated:** 03/13/2014