Downtown Dental

NPI #1073805735 in Boise, Idaho

Provider Information

NPI Number: 1073805735
Entity Type: Organization
Organization Name: Downtown Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: May 12, 2011
Last Updated: May 12, 2011

Practice Location

Address: 1625 W BANNOCK ST
City: Boise
State: Idaho
ZIP Code: 83702-5155
Phone: (208) 342-5444

Authorized Official

Name: DR. RYAN MICHAEL KOWALCZYK
Title: DENTIST
Phone: (208) 342-5444

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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