Healthcare Provider Details

I. General information

NPI: 1942114780
Provider Name (Legal Business Name): MCCALL DENTAL CARE - AD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 DEINHARD LN
MCCALL ID
83638-4703
US

IV. Provider business mailing address

327 DEINHARD LN
MCCALL ID
83638-4703
US

V. Phone/Fax

Practice location:
  • Phone: 208-634-3370
  • Fax:
Mailing address:
  • Phone: 208-634-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN SPEIRS
Title or Position: PRESIDENT
Credential: DMD
Phone: 208-634-3370