NPIMap

Organization Active NPI

Ikdo South Meridian LLC

  • Pediatric Dentistry
  • Meridian, ID
National Provider Identifier
1174145684
Registry record updated May 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
IKDO SOUTH MERIDIAN LLC
Practice address
3839 E Amity Rd
Meridian, ID 83642
Phone
(208) 999-4999
NPI assigned
May 7, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2020

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

Authorized official

Name
Michael D Payne, DMDNPI 1306968342
Title
Owner
Phone
(208) 884-4466

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

3839 E Amity Rd
Meridian, ID 83642

Mailing address

3289 N Towerbridge Way
Meridian, ID 83646-8347
Phone (208) 884-4466

National Provider Directory

National Provider Directory

Locations

3839 E Amity Rd
Meridian, ID 83642
Phone (208) 999-4999

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": "1588809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588809600000",
    "number": "1174145684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3289 N TOWERBRIDGE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836468347",
            "telephone_number": "208-884-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3839 E AMITY RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-999-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IKDO SOUTH MERIDIAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-07",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-884-4466",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.