NPIMap

Organization Active NPI

Hidden Creek Dental, PLLC

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1396554762
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
HIDDEN CREEK DENTAL, PLLC
Practice address
580 W Parkcenter Blvd
Boise, ID 83706-3659
Phone
(208) 336-8478
NPI assigned
Dec 31, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

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

Authorized official

Name
Dr. Ryan James Clark, DDSNPI 1356639892
Title
Sole Owner/Dentist
Phone
(208) 336-8478

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

580 W Parkcenter Blvd
Boise, ID 83706-3659

Mailing address

580 W Parkcenter Blvd
Boise, ID 83706-3659
Phone (208) 336-8478

National Provider Directory

National Provider Directory

Locations

580 W Parkcenter Blvd
Boise, ID 83706
Phone (208) 336-8478

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": "1735603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1396554762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 W PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063659",
            "telephone_number": "208-336-8478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 W PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063659",
            "telephone_number": "208-336-8478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIDDEN CREEK DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-31",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "SOLE OWNER/DENTIST",
        "authorized_official_telephone_number": "208-336-8478",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 31, 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.