NPIMap

Organization Active NPI

Victory Point Dental

  • General Practice Dentistry
  • Meridian, ID
National Provider Identifier
1578722765
Registry record updated Jun 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-3810 Issued in ID
Legal business name
VICTORY POINT DENTAL
Practice address
3175 S Meridian Rd
Suite 150
Meridian, ID 83642-7088
Phone
(208) 888-5470
Fax
(208) 288-0279
NPI assigned
Jun 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2008

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

Authorized official

Name
Dr. David M Lewis, DDSNPI 1124199237
Title
Owner/Dentist
Phone
(208) 888-5470

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 D-3810 ID Primary

Addresses

Primary practice location

3175 S Meridian Rd
Suite 150
Meridian, ID 83642-7088

Mailing address

3175 S Meridian Rd
Suite 150
Meridian, ID 83642-7088
Phone (208) 888-5470

Other identifiers 2

IdentifierTypeStateIssuer
01622474OtherIDUNITED CONCORDIA
806916200MedicaidID

National Provider Directory

National Provider Directory

Locations

3175 S Meridian Rd
Ste 150
Meridian, ID 83642
Phone (208) 888-5470

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": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1578722765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3175 S MERIDIAN RD",
            "address_2": "SUITE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427088",
            "telephone_number": "208-888-5470",
            "fax_number": "208-288-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3175 S MERIDIAN RD",
            "address_2": "SUITE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427088",
            "telephone_number": "208-888-5470",
            "fax_number": "208-288-0279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY POINT DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "208-888-5470",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "01622474",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806916200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 3, 2008; 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.