Individual
DR. TROY A CLOVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4552 N CLOVERDALE ROAD, BOISE, ID 83713-2417
(208) 376-2726
(208) 376-6401
Mailing address
4552 N CLOVERDALE ROAD, BOISE, ID 83713-2417
(208) 376-2726
(208) 376-6401
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3039
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42603
BLUE SHIELD
ID
01
—
61002
BLUE CROSS
ID
01
—
62644
TRICARE
ID
05
—
66D3039
—
ID
Enumeration date
11/14/2006
Last updated
07/08/2007
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