Provider Demographics
NPI:1730197849
Name:DAVIS, JEFFREY K (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 E PARKCENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6575
Mailing Address - Country:US
Mailing Address - Phone:208-384-9872
Mailing Address - Fax:
Practice Address - Street 1:651 E PARKCENTER BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6575
Practice Address - Country:US
Practice Address - Phone:208-384-9872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPD-38131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20-3727531OtherIRS FEDERAL TAX ID#
ID6O183 (LETTER O)OtherBLUE CROSS OF IDAHO INS.
IDN-01893OtherID STATE BOARD OF DENTIST
ID1615855OtherUNITED CONCORDIA INS.
IDCS10530OtherID STATE BOARD OF PHARM