Individual
DR. JON MICHAEL KOELTL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
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
1223G0001X
General Practice Dentistry
47744
CA
1223G0001X
General Practice Dentistry
Primary
D-5228
ID
Other
Enumeration date
03/28/2007
Last updated
04/29/2025
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