NPIMap

Organization Active NPI

Signature Dental PC

  • General Practice Dentistry
  • Meridian, ID
National Provider Identifier
1356500318
Registry record updated Jun 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3565 Issued in ID
Legal business name
SIGNATURE DENTAL PC
Practice address
1500 W Cayuse Creek Drive
Suite 100
Meridian, ID 83646
Phone
(208) 884-8858
Fax
(208) 884-8915
NPI assigned
Jun 5, 2008
Last updated
Jun 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2008

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

Authorized official

Name
Mr. Matthew L Kooyman, DDSNPI 1699782854
Title
Owner
Phone
(208) 884-8858

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D3565 ID Primary

Addresses

Primary practice location

1500 W Cayuse Creek Drive
Suite 100
Meridian, ID 83646

Mailing address

1500 W Cayuse Creek Drive
Suite 100
Meridian, ID 83646
Phone (208) 884-8858

Other identifiers 1

IdentifierTypeStateIssuer
1699782854OtherIDTYPE 1 NPI

National Provider Directory

National Provider Directory

Locations

1500 W Cayuse Creek Dr
Ste 100
Meridian, ID 83646
Phone (208) 884-8858

Practitioners & affiliated clinicians

Practitioners 1

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": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1356500318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 W CAYUSE CREEK DRIVE",
            "address_2": "SUITE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83646",
            "telephone_number": "208-884-8858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W CAYUSE CREEK DRIVE",
            "address_2": "SUITE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83646",
            "telephone_number": "208-884-8858",
            "fax_number": "208-884-8915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIGNATURE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "KOOYMAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-884-8858",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3565",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1699782854",
            "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 Jun 5, 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.