Avondale Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

AVONDALE DENTAL PLLC

Practice address

1683 E Miles Ave
Hayden Lake, ID 83835-9109

Phone

(208) 772-4066

NPI assigned

Aug 31, 2026

Last updated

Aug 31, 2026By 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

Kory Wilson, DDSNPI 1053503995

Title

Ceo

Phone

(208) 661-7879

Specialties & licenses 1

Addresses

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.

• Kory J Wilson, DDS

  • General Practice Dentistry
  • Spokane Valley, WA
  • NPI 1053503995
  NPD (past) Authorized official
• Kenneth John Bevan, D.D.S.

  • General Practice Dentistry
  • Napa, CA
  • NPI 1003960030
  NPD (past)
• Alexis Danielle Rollins, DDS

  • Dentist
  • Helena, MT
  • NPI 1659074268
  NPD (past)

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

{
    "created_epoch": "1788134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788134400000",
    "number": "1265340103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 W IRONWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142602",
            "telephone_number": "208-500-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1683 E MILES AVE",
            "city": "HAYDEN LAKE",
            "state": "ID",
            "postal_code": "838359109",
            "telephone_number": "208-772-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVONDALE DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-31",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-661-7879",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avondale Dental Center, L.L.C.
• Community Partnerships of Idaho, Inc
• Shannon N Cox, LMT, LE
• Paula Ione Dahlen, F-NP
• Tracy Jo Ellis, LMT
• Charles G Graves III, M.D.

• Dental Clinic/Center in Hayden Lake, ID
• Providers in Hayden Lake, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2026; 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.