Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Jon Michael Koeltl, DDS

Individual provider General Practice Dentistry · NPI 1477672533

Dr. Jon Michael Koeltl, DDS is a General Practice Dentistry in Boise, Idaho. Practices as a sole proprietor. Licensed in California and Idaho.

Licensed in
CA, ID
In the registry since
2007
Specialties on file
2
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

12349 W McMillan Rd
Boise, ID 83713-5052
Phone: (208) 322-1112
Fax: (208) 322-3928
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence D-5228 (ID)
General Practice Dentistry Taxonomy 1223G0001X · Licence 47744 (CA)

Record details

NPI number1477672533
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorYes
NPI enumeratedMarch 28, 2007
Last updated in NPPESApril 29, 2025
Certification dateApril 29, 2025
Mailing address12349 W McMillan Rd, Boise, ID 83713-5052

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