Individual provider Active NPI

Michael John Florence, DMD

  • Periodontics
  • Boise, ID
National Provider Identifier
1235147281
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
D1670 Issued in ID
Practice address
140 East Boise Avenue
Boise, ID 83706
Phone
(208) 385-9228
Fax
(208) 385-9228
NPI assigned
Aug 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X D1670 ID Primary

Addresses

Primary practice location

140 East Boise Avenue
Boise, ID 83706

Mailing address

140 East Boise Avenue
Boise, ID 83706
Phone (208) 385-9228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161018001477 ID Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 8426346883

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D1670IDMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Periodontal Health Specialists of Idaho Periodontics PastSince May 14, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235147281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 EAST BOISE AVENUE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83706",
            "telephone_number": "208-385-9228",
            "fax_number": "208-385-9292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 EAST BOISE AVENUE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83706",
            "telephone_number": "208-385-9228",
            "fax_number": "208-385-9228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLORENCE",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "ID",
            "license": "D1670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.