Boise Smiles Youth Dentistry, PLLC

Key facts

NPI

1033154604

Entity type

Organization (NPI type 2)

Primary specialty

General Practice Dentistry 1223G0001X

Legal business name

BOISE SMILES YOUTH DENTISTRY, PLLC

Practice address

8744 Fairview Ave
Boise, ID 83704-8207

Phone

(208) 322-3010

Fax

(208) 322-9273

NPI assigned

Jun 18, 2006

Organization subpart

No

Authorized official

Name

Mrs. Jenell Stump

Title

Manager, Licensing & Credentialing

Phone

(615) 750-0343

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Loren Joel Francis, DDS General Practice Dentistry · Boise, ID · NPI 1407944390
  NPD (past) GENERAL PRACTICE
• Maryam Hesami, DDS General Practice Dentistry · Boise, ID · NPI 1134229784
  NPD (past) GENERAL PRACTICE
• Jared J Hill General Practice Dentistry · Boise, ID · NPI 1144320797
  NPD (past) GENERAL PRACTICE
• Melinda M Jensen, DMD General Practice Dentistry · Boise, ID · NPI 1801095310
  NPD (past) GENERAL PRACTICE
• Riki Ryan Lambert, DDS Dentist · Boise, ID · NPI 1164412706
  NPD (past) GENERAL PRACTICE

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 9, 2014.

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404864000000",
    "number": "1033154604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 ARCADE UNIT 198747",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372191994",
            "telephone_number": "615-750-0343",
            "fax_number": "615-986-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8744 FAIRVIEW AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048207",
            "telephone_number": "208-322-3010",
            "fax_number": "208-322-9273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE SMILES YOUTH DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2014-07-09",
        "status": "A",
        "authorized_official_last_name": "STUMP",
        "authorized_official_first_name": "JENELL",
        "authorized_official_title_or_position": "MANAGER, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "615-750-0343",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807095000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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