Idaho Pediatric Dentistry

Primary specialty

Special HospitalTaxonomy code 284300000X

License

D3936PD Issued in ID

Legal business name

IDAHO PEDIATRIC DENTISTRY

Practice address

4401 E Flamingo Ave
Nampa, ID 83687-3113

Phone

(208) 461-5459

NPI assigned

Jun 9, 2008

Last updated

Jun 9, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kathi A Nelson

Title

Office Manager

Phone

(208) 461-5459

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Idaho Pediatric Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Idaho Pediatric Dentistry

  • Pediatric Dentistry
  • Nampa, ID
  • NPI 1467697177
  NPD tax ID

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1659530103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 E FLAMINGO AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836873113",
            "telephone_number": "208-461-5459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 E FLAMINGO AVE",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836873113",
            "telephone_number": "208-461-5459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "KATHI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-461-5459"
    },
    "taxonomies": [
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": "ID",
            "license": "D3936PD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805011445",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Idaho Family Physical Therapy PLLC (Idaho Family PT)
• Idaho Medical Products
• Idaho Medical Products
• Idaho Mental Wellness & Addiction Recovery PLLC
• Idaho Pediatric Dentistry
• Idaho Physical Therapy Inc.
• Idaho Physicians Eyecare Group, P.C.
• Idaho Sleep Services, LLC (Idaho Sleep Health)
• Idaho Sleep Solutions, LLC
• Idaho Surgical, LLC

• Special Hospital in Nampa, ID
• Providers in Nampa, ID by specialty
• Special Hospital in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.