Organization
JON KOELTL DDS, PC
Active
Other names
Centennial Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON MICHAEL KOELTL DDS (OWNER/DENTIST)
(208) 322-1112
Entity
Organization
Contact information
Practice address
12349 W MCMILLAN RD, BOISE, ID 83713-5052
(208) 322-1112
(208) 322-3928
Mailing address
12349 W MCMILLAN RD, BOISE, ID 83713-5052
(208) 322-1112
(208) 322-3928
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/29/2025
Last updated
04/29/2025
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