Jason Champagne Idaho 5, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JASON CHAMPAGNE IDAHO 5, PLLC

Practice address

5993 W State St Ste B
Boise, ID 83703-5058

Phone

(208) 939-1700

NPI assigned

May 9, 2024

Organization subpart

No

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

Authorized official

Name

Jason Champagne, DDS

Title

Owner

Phone

(775) 359-3934

Specialties & licenses 1

Addresses

Other names 1

• State Street Dental Doing business as

Locations

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

{
    "created_epoch": "1715212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1114775640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2070",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894322070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5993 W STATE ST STE B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035058",
            "telephone_number": "208-939-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASON CHAMPAGNE IDAHO 5, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-09",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "CHAMPAGNE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-359-3934",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Presley Danielle Jarvis, LPC
• Jason Champagne Idaho 1, PLLC
• Jason Champagne Idaho 2, PLLC
• Jason Champagne Idaho 3, PLLC
• Jason Champagne Idaho 4, PLLC
• Jasper Health, Inc.
• Stan M Jasper, LCSW
• Necole A Javernick-Hodges, M.D.
• Kathleen Jawish, LPC
• Jay W. Webb, PH.D., P.a.

• General Practice Dentistry in Boise, ID
• Providers in Boise, 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 May 9, 2024; 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.