Ryan T Kidman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4006 Issued in ID

Practice address

139 Alturas St
Idaho Falls, ID 83401-4309

Phone

(208) 523-5090

Fax

(208) 895-0583

NPI assigned

Nov 11, 2006

Last updated

Jun 7, 2023By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1163203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1033280136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 ALTURAS ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014309",
            "telephone_number": "208-523-5090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 ALTURAS ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014309",
            "telephone_number": "208-523-5090",
            "fax_number": "208-895-0583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDMAN",
        "first_name": "RYAN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-11",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807576700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Muad Khallad, MD
• Muhammad Arslan Khan, M.D.
• Naseem Khericha
• Thomas James Kibler
• Kid Connections, Inc
• Shania Marie Killian Skanch
• Joshua D Killpack, PA-C
• Weston Dean Killpack
• Kind Heart Inc
• Cassidy King

• General Practice Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, 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 Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.