Organization
DOWNTOWN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN MICHAEL KOWALCZYK (DENTIST)
(208) 342-5444
Entity
Organization
Contact information
Practice address
1625 W BANNOCK ST, BOISE, ID 83702-5155
(208) 342-5444
(208) 342-2076
Mailing address
1625 W BANNOCK ST, BOISE, ID 83702-5155
(208) 342-5444
(208) 342-2076
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3689
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6P481
BLUE CROSS OF IDAHO
ID
Enumeration date
05/12/2011
Last updated
05/12/2011
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