NPIMap

Organization Active NPI

Summit Dental Group

  • Dentist
  • Boise, ID
National Provider Identifier
1043343551
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D-1351 Issued in ID
Legal business name
SUMMIT DENTAL GROUP
Practice address
480 N Latah St
Boise, ID 83706-2630
Phone
(208) 345-8962
Fax
(208) 345-5207
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Authorized official

Name
Amy L. Leberman
Title
Admin
Phone
(208) 345-8962

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D-1351 ID Primary

Addresses

Primary practice location

480 N Latah St
Boise, ID 83706-2630

Mailing address

480 N Latah St
Boise, ID 83706-2630
Phone (208) 345-8962

National Provider Directory

National Provider Directory

Locations

480 N Latah St
Boise, ID 83706
Phone (208) 345-8962

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1043343551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 N LATAH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062630",
            "telephone_number": "208-345-8962",
            "fax_number": "208-345-5207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 N LATAH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837062630",
            "telephone_number": "208-345-8962",
            "fax_number": "208-345-5207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "LEBERMAN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "208-345-8962"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-1351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.