Hidden Creek Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-1699 Issued in ID

Legal business name

HIDDEN CREEK DENTAL

Practice address

580 W Parkcenter Blvd
Suite B
Boise, ID 83706-3659

Phone

(208) 336-8478

NPI assigned

Mar 2, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Harvey James Clark, DDS

Title

Owner

Phone

(208) 336-8478

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan James Clark, D.D.S.

  • General Practice Dentistry
  • Boise, ID
  • NPI 1356639892
  NPD (past)

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

{
    "created_epoch": "1488412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488412800000",
    "number": "1225578768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 W PARKCENTER BLVD",
            "address_2": "SUITE B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063659",
            "telephone_number": "208-336-8478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 W PARKCENTER BLVD",
            "address_2": "SUITE B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063659",
            "telephone_number": "208-336-8478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIDDEN CREEK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-02",
        "last_updated": "2017-03-02",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "HARVEY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-336-8478",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-1699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandon Clark Hicks, O.D.
• Michelle L Hicks, NP
• Nathan Hicks, MD
• Sue Marie Hicks, LCSW, CADC III
• Angela Kay Hidalgo
• Hidden Creek Dental, PLLC
• Hidden Springs Dental
• Hidden Springs Dental PLLC
• Hidden Springs Eye Care LLC
• Janette Michelle Hiebert, LMSW

• 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 Mar 2, 2017; 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.