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Active NPI 1659809200 Individual Practitioner Male Practitioner

Dr. Kimball Gray Mack , DMD

Dentist - General Practice • Boise, ID

Professional Overview & Biography Verified Profile Summary

Dr. Kimball Mack, DMD is a registered healthcare professional specializing in Dentist - General Practice in Boise, ID. Practice services are available at 4255 N EAGLE RD STE 102 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4255 N Eagle Rd Ste 102

Boise, ID 837130701

Telephone 2083446300
Fax 0829389906

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Boise, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 28.3 Yrs
Regional Practice Density
142 Specialists

Practicing in Boise, ID (781 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-08-28
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License ID D5587

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
NPI 1942416060

Doctor of Dental Medicine

Dr. Brant Burbank , DDS

Dentist - General Practice

NPI 1982260360

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 28, 2025

Dentist (License #D5587 in ID)

📍
Updated Practice Location August 12, 2024

Registered at 4255 N EAGLE RD STE 102, BOISE, ID 837130701 (Tel: 2083446300)

📍
Updated Business Mailing Address August 12, 2024

Registered at 4255 N EAGLE RD STE 102, BOISE, ID 837130701 (Tel: 2083446300)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 12, 2024

Dentist (License #D3935 in ID)

NPI Profile Active May 26, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location May 26, 2017

Registered at 1109 NORTHWEST HWY, GARLAND, TX 750415833 (Tel: (214) 227-4863)

📍
Updated Business Mailing Address May 26, 2017

Registered at 1109 NORTHWEST HWY, GARLAND, TX 750415833 (Tel: 2142274863)

👤
Provider Name / Credentials Updated May 26, 2017

Recorded as KIMBALL MACK, DMD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 26, 2017

Dentist (License #32859 in TX)

🟢
Initial NPI Registration & Enumeration May 26, 2017

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1659809200
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 26, 2017
Last Update: August 28, 2025
Sole Proprietor: Yes

Mailing Address

4255 N Eagle Rd Ste 102

Boise, ID 837130701

Phone: 2083446300

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.