NPIMap

Organization Active NPI

Stilson Dental Partnership PLLC

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1669984902
Registry record updated Oct 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3799 Issued in ID
Legal business name
STILSON DENTAL PARTNERSHIP PLLC
Practice address
813 N Stilson Rd Ste B
Boise, ID 83703-5119
Phone
(208) 342-4644
Fax
(208) 375-2008
NPI assigned
Oct 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2017

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

Authorized official

Name
Tyson N Gray, DMDNPI 1659457885
Title
Managing Partner
Phone
(208) 342-4644

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 3799 ID Primary

Addresses

Primary practice location

813 N Stilson Rd Ste B
Boise, ID 83703-5119

Mailing address

813 N Stilson Rd Ste B
Boise, ID 83703-5119
Phone (208) 342-4644

National Provider Directory

National Provider Directory

Locations

813 N Stilson Rd
Ste B
Boise, ID 83703
Phone (208) 342-4644

Practitioners & affiliated clinicians

Practitioners 5

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": "1508976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508976000000",
    "number": "1669984902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 N STILSON RD STE B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035119",
            "telephone_number": "208-342-4644",
            "fax_number": "208-375-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 N STILSON RD STE B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035119",
            "telephone_number": "208-342-4644",
            "fax_number": "208-375-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILSON DENTAL PARTNERSHIP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-26",
        "last_updated": "2017-10-26",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "TYSON",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "208-342-4644",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "3799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 26, 2017; 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.