Dentists of Boise and Orthodontics, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTISTS OF BOISE AND ORTHODONTICS, PC

Doing business as

Dentists of Boise and Orthodontics

Practice address

7500 W State St Ste 110
Boise, ID 83714-6074

Phone

(208) 258-7740

Fax

(208) 350-6895

NPI assigned

Jul 15, 2020

Last updated

Aug 5, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin Johnson, DDS

Title

Owner

Phone

(208) 258-7740

Specialties & licenses 1

Addresses

Other names 1

• Dentists of Boise and Orthodontics Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Brandon Astin, D.M.D.

  • Endodontics
  • Meridian, ID
  • NPI 1063870855
  NPD (past)
• Maximilian Miles Pacheco, DMD

  • General Practice Dentistry
  • Meridian, ID
  • NPI 1306524160
  NPD (past)
• Jakob Rodgers, DDS

  • Dentist
  • Star, ID
  • NPI 1194463778
  NPD (past)

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

{
    "created_epoch": "1594771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659657600000",
    "number": "1235747338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "303-852-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7500 W STATE ST STE 110",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837146074",
            "telephone_number": "208-258-7740",
            "fax_number": "208-350-6895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTISTS OF BOISE AND ORTHODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-15",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-258-7740",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dentists of Boise and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dentists of Boise and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cynthia Evon Dent, BS
• Ronald J Dent, EDD
• Dental Care West
• Dentistry for Children
• Dentistry One of Idaho PC
• Rebecca Lynn Deppen, RN
• Derek Derkacs, PA-C
• Avalon Noel Taylor Derlacki Prentiss, LPC
• Mary K Derlacki, FNP
• Dermaclinical, Inc.

• 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 Aug 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.