Id Oms Specialty Dental Services, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

ID OMS SPECIALTY DENTAL SERVICES, PLLC

Doing business as

Implants Northwest

Practice address

1859 N Lakewood Dr Ste 101
Coeur D Alene, ID 83814-2661

Phone

(208) 667-5565

NPI assigned

Feb 26, 2024

Last updated

Feb 26, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

ID OMS SPECIALTY DENTAL SERVICES, PLLCAs reported in NPPES

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

Authorized official

Name

Charlotte Dasch

Title

Director of Credentialing &PR

Phone

(504) 638-0303

Specialties & licenses 1

Addresses

Other names 1

• Implants Northwest Doing business as

Tax ID family

Id Oms Specialty Dental Services PLLC3 organizations share this tax ID, including this one

Part of

Id Oms Specialty Dental Services PLLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Id Oms Specialty Dental Services, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Coeur d'Alene, ID
  • NPI 1366119075
  NPD tax ID
• Id Oms Specialty Dental Services, PLLC

  dba Boise Oral Surgery & Implant Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Boise, ID
  • NPI 1467218552
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Id Oms Specialty Dental Services, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Coeur d'Alene, ID
  • NPI 1366119075
  NPPES parent name

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

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1245096338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 54TH AVE N STE 205",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372091442",
            "telephone_number": "615-678-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1859 N LAKEWOOD DR STE 101",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142661",
            "telephone_number": "208-667-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ID OMS SPECIALTY DENTAL SERVICES, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ID OMS SPECIALTY DENTAL SERVICES, PLLC",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "DASCH",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING &PR",
        "authorized_official_telephone_number": "504-638-0303"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Implants Northwest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tina Husky, LCSW
• Breanne Huss, CNM
• Jacob Hyde, DC
• David Hylton I
• Neil Ibrahim
• Id Oms Specialty Dental Services, PLLC
• Id Specialty Dental Services, PLLC (Riverstone Orthodontics)
• Idaho Dept of Health & Welfare Esc Region 1
• Idaho Dept of Health & Welfare Itp Reg. 1
• Idaho Dept of Health & Welfare Reg 1 Amh Clinic Cda

• Oral and Maxillofacial Surgery (Dentist) in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.