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General NPI Number Information
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NPI Number | 1992715304
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Entity Type | Individual
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Provider Name | TRAVIS BOYER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 716 YELLOWSTONE AVE
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City | POCATELLO
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State | ID
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Zip | 83201-4407
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Country | US
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Telephone | 208-478-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 332 S ORCHARD SPRINGS DR STE 110
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City | PUEBLO WEST
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State | CO
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Zip | 81007-6154
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Country | US
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Telephone | 719-924-8858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D3896
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 00202790
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License Number State | CO
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