NPIMap

Organization Active NPI

Ikdo Fruitland LLC

Doing business as Idaho Kids Dentistry & Orthodontics Fruitland

  • Pediatric Dentistry
  • Fruitland, ID
National Provider Identifier
1184108706
Registry record updated Apr 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
IKDO FRUITLAND LLC
Doing business as
Idaho Kids Dentistry & Orthodontics Fruitland
Practice address
1619 N Whitley Dr
Fruitland, ID 83619-2162
Phone
(208) 452-4444
Fax
(208) 452-3322
NPI assigned
Sep 19, 2018
Last updated
Apr 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2019

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

Authorized official

Name
Dr. Michael D Payne, DMDNPI 1306968342
Title
President
Phone
(208) 371-4445

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

1619 N Whitley Dr
Fruitland, ID 83619-2162

Mailing address

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

Other names 1

  • Idaho Kids Dentistry & Orthodontics Fruitland Doing business as

National Provider Directory

National Provider Directory

Locations

1619 N Whitley Dr
Fruitland, ID 83619
Phone (208) 452-4444

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1537315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555372800000",
    "number": "1184108706",
    "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": "1619 N WHITLEY DR",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192162",
            "telephone_number": "208-452-4444",
            "fax_number": "208-452-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IKDO FRUITLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-19",
        "last_updated": "2019-04-16",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-371-4445",
        "authorized_official_name_prefix": "Dr.",
        "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": [
        {
            "organization_name": "Idaho Kids Dentistry & Orthodontics Fruitland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Idaho Kids Dentistry & Orthodontics Fruitland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fruitland, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; 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.