Individual
DR. KIMBALL GRAY MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4255 N EAGLE RD STE 102, BOISE, ID 83713-0701
(208) 344-6300
(082) 938-9906
Mailing address
4255 N EAGLE RD STE 102, BOISE, ID 83713-0701
(208) 344-6300
(208) 938-9906
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5587
ID
Other
Enumeration date
05/26/2017
Last updated
08/28/2025
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