NPIMap

Organization Active NPI

John M Ukich, DDS,PA

  • Pediatric Dentistry
  • Coeur D Alene, ID
National Provider Identifier
1295906063
Registry record updated Mar 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D1656 Issued in ID
Legal business name
JOHN M UKICH, DDS,PA
Doing business as
Pediatric Dental Center of North Idaho
Practice address
1717 Lincoln Way
Suite 205
Coeur D Alene, ID 83814-2556
Phone
(208) 667-3556
Fax
(208) 066-4681
NPI assigned
Mar 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2008

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

Authorized official

Name
John M Ukich, DDSNPI 1902950041
Title
President
Phone
(208) 667-3556

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X D1656 ID Primary

Addresses

Primary practice location

1717 Lincoln Way
Suite 205
Coeur D Alene, ID 83814-2556

Mailing address

1717 Lincoln Way
Suite 205
Coeur D Alene, ID 83814-2556
Phone (208) 667-3556

Other names 1

  • Pediatric Dental Center of North Idaho Doing business as

National Provider Directory

National Provider Directory
Tax ID family
John M Ukich Ddspa2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1717 Lincoln Way
Ste 205
Coeur D Alene, ID 83814
Phone (208) 667-3556

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205884800000",
    "number": "1295906063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 LINCOLN WAY",
            "address_2": "SUITE 205",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142556",
            "telephone_number": "208-667-3556",
            "fax_number": "208-066-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 LINCOLN WAY",
            "address_2": "SUITE 205",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142556",
            "telephone_number": "208-667-3556",
            "fax_number": "208-066-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN M UKICH, DDS,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2008-03-19",
        "status": "A",
        "authorized_official_last_name": "UKICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-667-3556",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "ID",
            "license": "D1656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dental Center of North Idaho",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur D Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; 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.