CSC Dental PC

Key facts

NPI

1447921747

Entity type

Organization (NPI type 2)

Primary specialty

Dental Clinic/Center 261QD0000X

Legal business name

CSC DENTAL PC

Practice address

1550 E Heritage Park St Ste 150
Meridian, ID 83646-6440

Phone

(208) 288-2719

NPI assigned

Sep 26, 2021

Organization subpart

No

Authorized official

Name

Dr. Colton Charles, DMD NPI 1073826772

Title

Owner

Phone

(541) 908-1333

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

Practitioners 2

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

• Colton Charles, DMD General Practice Dentistry · Eagle, ID · NPI 1073826772
  NPD Authorized official
• Toby O Merriman, DMD Pediatric Dentistry · Meridian, ID · NPI 1407801939
  NPD (past)

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Happy Campers Pediatric Dental Other name
• Meridian Pediatric Dentistry Other name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 26, 2021.

{
    "created_epoch": "1632614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632614400000",
    "number": "1447921747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 E HERITAGE PARK ST STE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466440",
            "telephone_number": "208-288-2719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 E HERITAGE PARK ST STE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466440",
            "telephone_number": "208-288-2719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CSC DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-26",
        "last_updated": "2021-09-26",
        "certification_date": "2021-09-26",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "COLTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-908-1333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33495",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Happy Campers Pediatric Dental",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Meridian Pediatric Dentistry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Meridian, ID

• Jennifer L Cruise, CSFA
• Jarrod Vaughn Crump, NP
• William L Crump III, MD
• Jay M. Crutchfield, MD FACS
• Krista Crutchfield, PTA
• CSRM LLC
• Clinton Cullins, LDN
• Alyse Culpepper, MA
• Cultivate Counseling, LLC
• Hannah Lynn Cummings, MS CF-SLP

All providers in Meridian, ID · Dental Clinic/Center in Idaho