NPIMap

Organization Active NPI

Korth B. Elliott, DDS

  • Dentist
  • Boise, ID
National Provider Identifier
1679749212
Registry record updated May 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D-1996 Issued in ID
Legal business name
KORTH B. ELLIOTT, DDS
Practice address
8219 Northview St
Boise, ID 83704-7131
Phone
(208) 378-9280
NPI assigned
May 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2008

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

Authorized official

Name
Korth B Elliott, DDSNPI 1477683019
Title
Owner
Phone
(208) 378-9280

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D-1996 ID Primary

Addresses

Primary practice location

8219 Northview St
Boise, ID 83704-7131

Mailing address

8219 Northview St
Boise, ID 83704-7131
Phone (208) 378-9280

Other identifiers 1

IdentifierTypeStateIssuer
002652300MedicaidID

National Provider Directory

National Provider Directory

Locations

8219 W Northview St
Boise, ID 83704
Phone (208) 378-9280

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": "1209859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209859200000",
    "number": "1679749212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8219 NORTHVIEW ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837047131",
            "telephone_number": "208-378-9280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8219 NORTHVIEW ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837047131",
            "telephone_number": "208-378-9280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KORTH B. ELLIOTT, DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-04",
        "last_updated": "2008-05-04",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "KORTH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-378-9280",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-1996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002652300",
            "state": "ID"
        }
    ],
    "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 May 4, 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.