Organization
SEASONS DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRAVIS T BODILY D.M.D. (OWNER)
(208) 679-1679
Entity
Organization
Contact information
Practice address
425 N OVERLAND AVE, BURLEY, ID 83318-3434
(208) 679-1679
Mailing address
425 N OVERLAND AVE, BURLEY, ID 83318-3434
(208) 679-1679
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4151
ID
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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