NPIMap

Organization Active NPI

Meridian Dental, PLLC

  • General Practice Dentistry
  • Meridian, ID
National Provider Identifier
1295741957
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MERIDIAN DENTAL, PLLC
Practice address
780 W Cherry LN
Meridian, ID 83642-1617
Phone
(208) 888-4711
Fax
(208) 888-0308
NPI assigned
Aug 1, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Allyson Kousky
Title
Insurance Manager
Phone
(208) 888-4711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

780 W Cherry LN
Meridian, ID 83642-1617

Mailing address

780 W Cherry LN
Meridian, ID 83642-1617
Phone (208) 888-4711

Other identifiers 1

IdentifierTypeStateIssuer
134932OtherIDTRI-CARE

National Provider Directory

National Provider Directory

Locations

780 W Cherry Ln
Meridian, ID 83642
Phone (208) 888-4711

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295741957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 W CHERRY LN",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421617",
            "telephone_number": "208-888-4711",
            "fax_number": "208-888-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 W CHERRY LN",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421617",
            "telephone_number": "208-888-4711",
            "fax_number": "208-888-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOUSKY",
        "authorized_official_first_name": "ALLYSON",
        "authorized_official_title_or_position": "INSURANCE MANAGER",
        "authorized_official_telephone_number": "208-888-4711",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI-CARE",
            "identifier": "134932",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • 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.