Boise Premier Dentistry

Key facts

NPI

1689258758

Entity type

Organization (NPI type 2)

Primary specialty

Dentist 122300000X

Legal business name

BOISE PREMIER DENTISTRY

Practice address

3809 W State St
Boise, ID 83703-5221

Phone

(208) 551-5155

NPI assigned

May 5, 2021

Organization subpart

No

Authorized official

Name

Maryam Moghaddasian, DDS

Title

Owner

Phone

(208) 794-6391

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Maryam Torab Parhiz, DDS General Practice Dentistry · St.Clair Shores, MI · NPI 1932416476
  NPD

National Provider Directory

Locations

Specialties & licenses

Addresses

Other names

• Boise Premier Dentistry Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 5, 2021.

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1689258758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3809 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035221",
            "telephone_number": "208-551-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3809 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035221",
            "telephone_number": "208-551-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE PREMIER DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-05",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "MOGHADDASIAN",
        "authorized_official_first_name": "MARYAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-794-6391",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boise Premier Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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