NPIMap

Organization Active NPI

Idaho Endodontics

  • Endodontics
  • Boise, ID
National Provider Identifier
1710509823
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
Legal business name
IDAHO ENDODONTICS
Practice address
1555 S Timesquare LN
Boise, ID 83709-8266
Phone
(208) 672-8860
NPI assigned
May 12, 2020
Last updated
May 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Authorized official

Name
Amanda Maylin, DO
Title
Front Office
Phone
(208) 672-8860

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X NU Primary

Addresses

Primary practice location

1555 S Timesquare LN
Boise, ID 83709-8266

Mailing address

1555 S Timesquare LN
Boise, ID 83709-8266
Phone (208) 672-8860

National Provider Directory

National Provider Directory

Locations

1555 S Timesquare Ln
Boise, ID 83709
Phone (208) 672-8860

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1710509823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 S TIMESQUARE LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837098266",
            "telephone_number": "208-672-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 S TIMESQUARE LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837098266",
            "telephone_number": "208-672-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO ENDODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-12",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "MAYLIN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "FRONT OFFICE",
        "authorized_official_telephone_number": "208-672-8860",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NU",
            "license": null,
            "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 May 12, 2020; 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.