NPIMap

Organization Active NPI

Millennium Family Dental - Boise LLC

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1104925064
Registry record updated Dec 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MILLENNIUM FAMILY DENTAL - BOISE LLC
Practice address
813 Stilson Rd
Suite B
Boise, ID 83703
Phone
(208) 342-4644
Fax
(208) 367-0283
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2014

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

Authorized official

Name
Jennifer Lynn Viquelia
Title
Office Manager
Phone
(208) 888-2026

Specialties & licenses 1

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

Addresses

Primary practice location

813 Stilson Rd
Suite B
Boise, ID 83703

Mailing address

1848 Millenium Way
Meridian, ID 83642
Phone (208) 888-2026

Other identifiers 1

IdentifierTypeStateIssuer
806766100MedicaidID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419897600000",
    "number": "1104925064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 MILLENIUM WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-888-2026",
            "fax_number": "208-888-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 STILSON RD",
            "address_2": "SUITE B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83703",
            "telephone_number": "208-342-4644",
            "fax_number": "208-367-0283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENNIUM FAMILY DENTAL - BOISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2014-12-30",
        "status": "A",
        "authorized_official_last_name": "VIQUELIA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-888-2026"
    },
    "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": "806766100",
            "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 Dec 30, 2014; 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.