Bluesky Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3597 Issued in ID

Legal business name

BLUESKY DENTAL

Practice address

2500 W a St Ste 204
Moscow, ID 83843-6000

Phone

(208) 882-9111

Fax

(208) 882-3279

NPI assigned

Jun 15, 2011

Last updated

Jun 15, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kevin C Henry, DDS

Title

Owner

Phone

(208) 882-9111

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308096000000",
    "number": "1073808333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W A ST STE 204",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838436000",
            "telephone_number": "208-882-9111",
            "fax_number": "208-882-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W A ST STE 204",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838436000",
            "telephone_number": "208-882-9111",
            "fax_number": "208-882-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUESKY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-15",
        "last_updated": "2011-06-15",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-882-9111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kimberley D Blewett, D.O.
• Bloomin Family Therapy, LLC
• Elizabeth Bonanni, ATC
• Morgan E Bond, LMSW
• Jessica E Bonnett, DO
• Kathryn Bonzo, LPC
• Megan Brooke Borchert, MS, ATC

• General Practice Dentistry in Moscow, ID
• Providers in Moscow, 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 15, 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.