NPIMap

Organization Active NPI

Downtown Dental

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1073805735
Registry record updated May 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-3689 Issued in ID
Legal business name
DOWNTOWN DENTAL
Practice address
1625 W Bannock St
Boise, ID 83702-5155
Phone
(208) 342-5444
Fax
(208) 342-2076
NPI assigned
May 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2011

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

Authorized official

Name
Dr. Ryan Michael KowalczykNPI 1023121795
Title
Dentist
Phone
(208) 342-5444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D-3689 ID Primary

Addresses

Primary practice location

1625 W Bannock St
Boise, ID 83702-5155

Mailing address

1625 W Bannock St
Boise, ID 83702-5155
Phone (208) 342-5444

Other identifiers 1

IdentifierTypeStateIssuer
6P481OtherIDBLUE CROSS OF IDAHO

National Provider Directory

National Provider Directory
Tax ID family
Downtown Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1305158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305158400000",
    "number": "1073805735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 W BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025155",
            "telephone_number": "208-342-5444",
            "fax_number": "208-342-2076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 W BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025155",
            "telephone_number": "208-342-5444",
            "fax_number": "208-342-2076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOWNTOWN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-12",
        "last_updated": "2011-05-12",
        "status": "A",
        "authorized_official_last_name": "KOWALCZYK",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-342-5444",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "6P481",
            "state": "ID"
        }
    ],
    "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 May 12, 2011; 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.