Robert Ackerman, D.D.S.
Individual provider Active NPI General Practice Dentistry · Boise, ID
NPI 1003973850 · NPPES record last updated Jul 5, 2023
Key facts
- NPI
- 1003973850
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3088 (ID)
- Practice address
- 10200 W Emerald St
Suite 105
Boise, ID 83704-8900 - Phone
- (208) 376-7954
- NPI assigned
- Jan 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3088 | ID | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quality Family Dentistry | Past | Accepting new patients | |
| Sanders Dental PLLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3088 | ID | Yes |
Addresses
Primary practice location
10200 W Emerald St
Suite 105
Boise, ID 83704-8900
Mailing address
1003 E Clearvue CT
Eagle, ID 83616-6460
Phone (208) 884-3934
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 82-0499472 | Other | ID | TAX ID # |
| 3088 | Other | ID | LICENSE # |
Other providers in Boise, ID
- Achieve Physical Therapy PLLC
- Achieve, LLC
- Acjcs
- Daniel Bryan Ackerman
- Jerrod Ackerman
- Aaron Ackerson
- Matthew Ryan Ackley
- Nicole Lynn Ackley
- Acme Markets Inc
- Acme Markets Inc
All providers in Boise, ID · General Practice Dentistry in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.