Koalby Brown

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4924 Issued in ID

Practice address

13219 W Persimmon LN
Boise, ID 83713-1986

Phone

(208) 373-0018

Fax

(208) 378-9676

NPI assigned

Jun 1, 2018

Last updated

Apr 30, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brookdale Dental, PA

  • General Practice Dentistry
  • Boise, ID
  • NPI 1497926521
  NPD (past)
• Two Rivers Family & Cosmetic Dentistry, PA

  • Dentist
  • Grangeville, ID
  • NPI 1306362587
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777507200000",
    "number": "1437641735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13219 W PERSIMMON LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131986",
            "telephone_number": "208-373-0018",
            "fax_number": "208-378-9676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13219 W PERSIMMON LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131986",
            "telephone_number": "208-373-0018",
            "fax_number": "208-378-9676"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "307 E Park St Ste 203",
            "address_purpose": "LOCATION",
            "city": "McCall",
            "state": "ID",
            "postal_code": "836385255",
            "country_code": "US",
            "telephone_number": "208-634-5255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 N A St",
            "address_purpose": "LOCATION",
            "city": "Grangeville",
            "state": "ID",
            "postal_code": "835301211",
            "country_code": "US",
            "telephone_number": "208-983-1651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROWN",
        "first_name": "KOALBY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-01",
        "last_updated": "2026-04-30",
        "certification_date": "2026-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Brianne Brown, LMSW
• Jeremiah Brown, D.M.D.
• Kaitlyn Marie Brown, DPT
• Karla Brown, OT
• Katie Lynn Brown, LCSW
• Krista Brown, RD, LD
• Kristin Marie Brown, RN
• Lawrence E Brown, MD
• Lindsay Ann Brown, SLP
• Marisa Denise Brown, ODP

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.