Individual
DR. CALVIN TYLER SKINNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1175 E PARKCENTER BLVD, BOISE, ID 83706-6751
(208) 888-5544
Mailing address
1455 E JADE CREEK ST, EAGLE, ID 83616-7521
(208) 987-0402
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11305
OR
1223G0001X
General Practice Dentistry
Primary
4871762
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/05/2020
Last updated
01/27/2026
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