NPIMap

Organization Active NPI

Id Specialty Dental Services, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Pocatello, ID
National Provider Identifier
1013757830
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
ID SPECIALTY DENTAL SERVICES, PLLC
Practice address
625 E Alameda Rd
Pocatello, ID 83201-3622
Phone
(208) 237-0005
NPI assigned
May 29, 2024
Organization subpart
Yes
Parent organization
ID SPECIALTY DENTAL SERVICES, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Authorized official

Name
Charlotte Dasch
Title
Director of Cred and Prov Rel
Phone
(504) 638-0303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

625 E Alameda Rd
Pocatello, ID 83201-3622

Mailing address

1610 54TH Ave N Ste 205
Nashville, TN 37209-1442
Phone (615) 678-0759

Other names 1

  • Idaho Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Id Specialty Dental Services PLLC5 organizations share this tax ID, including this one
Part of
Id Specialty Dental Services PLLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1013757830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 54TH AVE N STE 205",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372091442",
            "telephone_number": "615-678-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E ALAMEDA RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013622",
            "telephone_number": "208-237-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ID SPECIALTY DENTAL SERVICES, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ID SPECIALTY DENTAL SERVICES, PLLC",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "DASCH",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "DIRECTOR OF CRED AND PROV REL",
        "authorized_official_telephone_number": "504-638-0303"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.