Individual
DR. JEFFREY K DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
651 E PARKCENTER BLVD, BOISE, ID 83706-6575
(208) 384-9872
Mailing address
651 E PARKCENTER BLVD, BOISE, ID 83706-6575
(208) 384-9872
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
PD-3813
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1615855
UNITED CONCORDIA INS.
ID
01
—
20-3727531
IRS FEDERAL TAX ID#
ID
01
—
6O183 (LETTER O)
BLUE CROSS OF IDAHO INS.
ID
01
—
CS10530
ID STATE BOARD OF PHARM
ID
01
—
N-01893
ID STATE BOARD OF DENTIST
ID
Enumeration date
08/04/2006
Last updated
04/16/2025
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