NPIMap

Organization Active NPI

Idaho Dental Professionals, P.C.

  • General Practice Dentistry
  • Meridian, ID
National Provider Identifier
1376304451
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
IDAHO DENTAL PROFESSIONALS, P.C.
Practice address
283 S Ten Mile Rd
Meridian, ID 83642-6105
Phone
(208) 639-1017
Fax
(208) 639-1069
NPI assigned
Jan 17, 2024
Organization subpart
Yes
Parent organization
IDAHO DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Authorized official

Name
Cemyira McDougal
Title
Credentialing
Phone
(217) 764-8609

Specialties & licenses 1

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

Addresses

Primary practice location

283 S Ten Mile Rd
Meridian, ID 83642-6105

Mailing address

283 S Ten Mile Rd
Meridian, ID 83642-6105
Phone (208) 639-1017

Other names 1

  • White Pine Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Idaho Dental Professionals PC9 organizations share this tax ID, including this one
Part of
Idaho Dental Professionals PC

Other organizations with this tax ID 8

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

Locations

283 S Ten Mile Rd
Meridian, ID 83642
Phone (208) 639-1017

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": "1705449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1376304451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "283 S TEN MILE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426105",
            "telephone_number": "208-639-1017",
            "fax_number": "208-639-1069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 S TEN MILE RD",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426105",
            "telephone_number": "208-639-1017",
            "fax_number": "208-639-1069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IDAHO DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "MCDOUGAL",
        "authorized_official_first_name": "CEMYIRA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Pine Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 17, 2024; 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.