Healthcare Provider Details

I. General information

NPI: 1992645717
Provider Name (Legal Business Name): IDAHO EMERGENCY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 E GALA ST STE 200
MERIDIAN ID
83642-4880
US

IV. Provider business mailing address

PO BOX 4024
BOISE ID
83711-4024
US

V. Phone/Fax

Practice location:
  • Phone: 208-284-4481
  • Fax:
Mailing address:
  • Phone: 208-284-4481
  • 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. STEPHEN LEEB
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 507-779-6475