Individual
TRAVIS BOYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
716 YELLOWSTONE AVE, POCATELLO, ID 83201-4407
(208) 478-5437
Mailing address
332 S ORCHARD SPRINGS DR STE 110, PUEBLO WEST, CO 81007-6154
(719) 924-8858
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
00202790
CO
1223G0001X
General Practice Dentistry
D3896
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07178506
—
CO
05
—
200533690A
—
OK
05
—
807402500
—
ID
Enumeration date
08/08/2006
Last updated
03/27/2018
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