KSS Dental Group PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3315 Issued in ID

Legal business name

KSS DENTAL GROUP PLLC

Doing business as

Fairview Dental

Practice address

329 E Logan St
Caldwell, ID 83605-4863

Phone

(208) 459-3388

Fax

(208) 453-9295

NPI assigned

Jul 19, 2016

Last updated

Jul 19, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

KSS DENTAL GROUP PLLCAs reported in NPPES

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

Authorized official

Name

Dr. Keith L Stucki, DMD

Title

Manager

Phone

(208) 459-3388

Specialties & licenses 1

Addresses

Other names 1

• Fairview Dental Doing business as

Part of

KSS Dental Group PLLC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468886400000",
    "number": "1457704009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 E LOGAN ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054863",
            "telephone_number": "208-459-3388",
            "fax_number": "208-453-9295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 E LOGAN ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054863",
            "telephone_number": "208-459-3388",
            "fax_number": "208-453-9295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSS DENTAL GROUP PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KSS DENTAL GROUP PLLC",
        "enumeration_date": "2016-07-19",
        "last_updated": "2016-07-19",
        "status": "A",
        "authorized_official_last_name": "STUCKI",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-459-3388",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairview Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kool Ridez LLC
• Koolridez L.L.C.
• Stephanie Koopman, LMSW
• Jaret Koudelka, PHARM. D.
• Leanne M Kovick, CFM
• Gloria Marie Lamb-Condosta, PHARMD
• Stacy Jane Lamers, DO
• Bailey Rheann Landon
• Brandon Lane, PA
• Michelle Lanigan

• General Practice Dentistry in Caldwell, ID
• Providers in Caldwell, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2016; 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.