Healthcare Provider Details

I. General information

NPI: 1831982958
Provider Name (Legal Business Name): ROYAL DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2398 E GOWEN RD
BOISE ID
83716-6707
US

IV. Provider business mailing address

11496 W PECONIC CT
BOISE ID
83709-3316
US

V. Phone/Fax

Practice location:
  • Phone: 702-704-5467
  • Fax:
Mailing address:
  • Phone: 702-704-5467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HOWARD ROBINSON
Title or Position: PRESIDENT
Credential: DMD
Phone: 702-704-5467