Organization
IDEAL DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS BOYER (OWNER)
(208) 459-3388
Entity
Organization
Contact information
Practice address
329 E LOGAN ST, CALDWELL, ID 83605-4863
(208) 459-3388
(208) 453-9295
Mailing address
329 E LOGAN ST, CALDWELL, ID 83605-4863
(208) 459-3388
(208) 453-9295
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3896
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194808238
NPI
ID
01
—
1992715304
NPI
ID
Enumeration date
08/02/2011
Last updated
08/02/2011
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