Individual provider · Type 1 NPI

Keaton Nicholson

Periodontics · Boise, ID

NPI number 1902749864 Active

Practice location

140 E Boise Ave
Boise, ID 83706-4302

Call (208) 385-9228 Map

Specialties and licenses

TaxonomyCodeLicense
Periodontics Primary 1223P0300X1781902 (ID)

Periodontics: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

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About NPI 1902749864

Keaton Nicholson's National Provider Identifier is 1902749864, issued on Apr 13, 2026. The primary taxonomy on file is Periodontics (1223P0300X), and the practice location is in Boise, ID. The record was last updated on Aug 17, 2026.