NPIMap

Organization Active NPI

Idaho Dental Professionals, P.C.

Doing business as A Reason to Smile

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1114532645
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
IDAHO DENTAL PROFESSIONALS, P.C.
Doing business as
A Reason to Smile
Practice address
2803 N Bogus Basin Rd
Boise, ID 83702-0913
Phone
(208) 343-1393
NPI assigned
Sep 11, 2020
Last updated
Sep 11, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
HEARTLAND DENTALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Authorized official

Name
Tabatha Lemke
Title
Credentialing Coordinator
Phone
(217) 540-6078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

2803 N Bogus Basin Rd
Boise, ID 83702-0913

Mailing address

2803 N Bogus Basin Rd
Boise, ID 83702-0913

Other names 1

  • A Reason to Smile Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Idaho Dental Professionals PC9 organizations share this tax ID, including this one
Part of
Idaho Dental Professionals PC

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1114532645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2803 N BOGUS BASIN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837020913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2803 N BOGUS BASIN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837020913",
            "telephone_number": "208-343-1393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEARTLAND DENTAL",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-10",
        "status": "A",
        "authorized_official_last_name": "LEMKE",
        "authorized_official_first_name": "TABATHA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-6078"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "A Reason to Smile",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 11, 2020; 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.