# SEASONS DENTAL

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

## Provider details

- **NPI number:** 1982157962
- **Authorized official:** DR. TRAVIS T BODILY D.M.D. (OWNER)
- **Authorized official phone:** (208) 679-1679

## Contact information

- **Practice address:** 425 N OVERLAND AVE, BURLEY, ID 83318-3434
- **Practice address phone:** (208) 679-1679
- **Mailing address:** 425 N OVERLAND AVE, BURLEY, ID 83318-3434
- **Mailing address phone:** (208) 679-1679

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4151 | ID | Yes |

## Other

- **Enumeration date:** 07/26/2016
- **Last updated:** 07/26/2016