Kootenai Dental Group, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

ID03049 Issued in ID

Legal business name

KOOTENAI DENTAL GROUP, LLC

Practice address

555 W. Canfield Avenue
Coeur D'Alene, ID 83815-7892

Phone

(208) 762-8750

Fax

(208) 762-2530

NPI assigned

Sep 22, 2006

Last updated

Aug 22, 2020By 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

Dr. Delwyn Lee Dick, DDSNPI 1134391436

Title

Ceo

Phone

(208) 762-8750

Specialties & licenses 1

Addresses

Other names 1

• DeLwyn Lee Dick, D.D.S. Other name

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.

• Delwyn Lee Dick, D.D.S.

  • General Practice Dentistry
  • Coeur d'Alene, ID
  • NPI 1134391436
  NPD (past) Authorized official
• Amanda Suzanne Roper, DDS

  • General Practice Dentistry
  • Coeur d'Alene, ID
  • NPI 1326228883
  NPD (past)
• Miranda Lynn Weber, DDS

  • Dentist
  • Post Falls, ID
  • NPI 1831884436
  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265532261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W. CANFIELD AVENUE",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "838157892",
            "telephone_number": "208-762-8750",
            "fax_number": "208-762-2530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W. CANFIELD AVENUE",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "838157892",
            "telephone_number": "208-762-8750",
            "fax_number": "208-762-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOTENAI DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DICK",
        "authorized_official_first_name": "DELWYN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-762-8750",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "ID03049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeLwyn Lee Dick, D.D.S.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Natalie D. Koncz, PA-C
• Angela Meghan Konegni, MS, RD, CSR, LD
• Carol Ann Kontos, PT
• Kootenai Audiology, LLC
• Kootenai County Emergency Medical Services System
• Kootenai Family Dental PLLC
• Kootenai Family Dental, PA
• Kootenai Health, Inc. (Kootenai Clinics Cancer Services Pharmacy)
• Kootenai Health, Inc.
• Kootenai Health, Inc. (Kootenai Health Pharmacy)

• General Practice Dentistry in Coeur d'Alene, ID
• Providers in Coeur d'Alene, 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 22, 2020; 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.