Organization
CHOICE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRENT M KELLY DDS (DENTIST)
(208) 999-4746
Entity
Organization
Contact information
Practice address
1991 W BROADWAY ST, IDAHO FALLS, ID 83402-3041
(208) 999-4746
(208) 357-4911
Mailing address
1991 W BROADWAY ST, IDAHO FALLS, ID 83402-3041
(208) 999-4746
(208) 357-4911
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
124Q00000X
Dental Hygienist
—
—
Other
Enumeration date
05/21/2021
Last updated
05/21/2021
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