Provider Demographics
NPI:1790126845
Name:TAFOYA, TREVOR E (DMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:E
Last Name:TAFOYA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2598 E LA GRANGE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4773
Mailing Address - Country:US
Mailing Address - Phone:208-447-7555
Mailing Address - Fax:
Practice Address - Street 1:7421 W VICTORY RD STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5106
Practice Address - Country:US
Practice Address - Phone:208-402-1040
Practice Address - Fax:866-324-2220
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-45041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice