Koalby Brown

NPI 1437641735 · on the registry since 2018 · sole proprietor

Practice

Address: 13219 W Persimmon Ln
Boise, ID 83713
Phone: (208) 373-0018
Fax: (208) 378-9676
Organisation at this address: Brookdale Dental, Pa
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 2

Additional practice sites

307 E Park St Ste 203, Mccall, ID
120 N A St, Grangeville, ID

Registry record

Primary taxonomy: 1223G0001X
1223G0001X
Licence states on file: ID
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2026-04-30

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho