NPIMap

Organization Active NPI

Id Oms Specialty Dental Services, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Boise, ID
National Provider Identifier
1467218552
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
ID OMS SPECIALTY DENTAL SERVICES, PLLC
Practice address
7910 W Ustick Rd
Boise, ID 83704-5850
Phone
(208) 322-5522
NPI assigned
Feb 26, 2024
Organization subpart
Yes
Parent organization
ID OMS SPECIALTY DENTAL SERVICES, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Charlotte Dasch
Title
Director of Credentialing and PR
Phone
(615) 678-0759

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

7910 W Ustick Rd
Boise, ID 83704-5850

Mailing address

1610 54TH Ave N Ste 205
Nashville, TN 37209-1442
Phone (615) 678-0759

Other names 1

  • Boise Oral Surgery & Implant Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Id Oms Specialty Dental Services PLLC3 organizations share this tax ID, including this one
Part of
Id Oms Specialty Dental Services PLLC

Other organizations with this tax ID 2

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

Locations

7910 W Ustick Rd
Boise, ID 83704
Phone (208) 322-5522

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1708905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1467218552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 54TH AVE N STE 205",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372091442",
            "telephone_number": "615-678-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 W USTICK RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045850",
            "telephone_number": "208-322-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ID OMS SPECIALTY DENTAL SERVICES, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ID OMS SPECIALTY DENTAL SERVICES, PLLC",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "DASCH",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING AND PR",
        "authorized_official_telephone_number": "615-678-0759"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boise Oral Surgery & Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 26, 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.