Healthcare Provider Details

I. General information

NPI: 1972418788
Provider Name (Legal Business Name): HIGH DEFINITION DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5993 W STATE ST STE B
BOISE ID
83703-5058
US

IV. Provider business mailing address

5993 W STATE ST STE B
BOISE ID
83703-5058
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-1700
  • Fax:
Mailing address:
  • Phone: 208-939-1700
  • 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: DR. TRAVIS WEIMER
Title or Position: CO-OWNER
Credential: DDS
Phone: 541-805-0389