NPIMap

Organization Active NPI

Southwest Dental Associates

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1124346499
Registry record updated May 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D2065 Issued in ID
Legal business name
SOUTHWEST DENTAL ASSOCIATES
Practice address
1201 S Five Mile Rd
Boise, ID 83709-1304
Phone
(208) 322-5655
Fax
(208) 323-8160
NPI assigned
May 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2010

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

Authorized official

Name
Dr. Jeffrey Tuller, DDSNPI 1285641589
Title
Dentist
Phone
(208) 322-5655

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 D2065 ID Primary

Addresses

Primary practice location

1201 S Five Mile Rd
Boise, ID 83709-1304

Mailing address

1201 S Five Mile Rd
Boise, ID 83709-1304
Phone (208) 322-5655

National Provider Directory

National Provider Directory
Tax ID family
Idaho Smiles Assoc PLLS2 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 3

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": "1273622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273622400000",
    "number": "1124346499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 S FIVE MILE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091304",
            "telephone_number": "208-322-5655",
            "fax_number": "208-323-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S FIVE MILE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091304",
            "telephone_number": "208-322-5655",
            "fax_number": "208-323-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-12",
        "last_updated": "2010-05-12",
        "status": "A",
        "authorized_official_last_name": "TULLER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-322-5655",
        "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": "D2065",
            "primary": true
        }
    ],
    "identifiers": [],
    "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, 2010; 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.