NPIMap

Organization Active NPI

TMD PLLC

  • Dentist
  • Boise, ID
National Provider Identifier
1366601734
Registry record updated Sep 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D3273 Issued in ID
Legal business name
TMD PLLC
Practice address
2031 E Hospitality LN
Suite 100
Boise, ID 83716-6603
Phone
(208) 333-9999
Fax
(208) 343-5889
NPI assigned
Jun 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2011

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

Authorized official

Name
Mrs. Michelle D Ryan
Title
Office Manager
Phone
(208) 333-9999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D3273 ID Primary

Addresses

Primary practice location

2031 E Hospitality LN
Suite 100
Boise, ID 83716-6603

Mailing address

2031 E Hospitality LN
Suite 100
Boise, ID 83716-6603
Phone (208) 333-9999

Other names 1

  • Modern Dental Other name

National Provider Directory

National Provider Directory

Locations

2031 E Hospitality Ln
#100
Boise, ID 83716
Phone (208) 333-9999

Practitioners & affiliated clinicians

Practitioners 1

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": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315267200000",
    "number": "1366601734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2031 E HOSPITALITY LN",
            "address_2": "SUITE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837166603",
            "telephone_number": "208-333-9999",
            "fax_number": "208-343-5889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2031 E HOSPITALITY LN",
            "address_2": "SUITE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837166603",
            "telephone_number": "208-333-9999",
            "fax_number": "208-343-5889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-02",
        "last_updated": "2011-09-06",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-333-9999",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; 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.