Black Bear Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

BLACK BEAR DENTAL PLLC

Practice address

600 E Riverpark LN Ste 140
Boise, ID 83706-6509

Phone

(208) 906-3860

NPI assigned

Aug 14, 2024

Organization subpart

No

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

Authorized official

Name

Mary Krajicek, DDSNPI 1265841183

Title

Dentist

Phone

(208) 906-3860

Specialties & licenses 1

Addresses

Other names 1

• Parkcenter Smiles Doing business as

Practitioners 1

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

• Mary Krajicek

  • General Practice Dentistry
  • Sunnyvale, CA
  • NPI 1265841183
  NPD Authorized official

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

{
    "created_epoch": "1723593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1710719216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E RIVERPARK LN STE 140",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066509",
            "telephone_number": "208-906-3860",
            "fax_number": "208-906-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E RIVERPARK LN STE 140",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066509",
            "telephone_number": "208-906-3860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK BEAR DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-14",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "KRAJICEK",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-906-3860",
        "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": "Parkcenter Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Clay T Bistline
• Bitterroot Counseling, LLC
• Abby Rae Bittick, LMSW
• Tracy Bjork, LCSW
• Sharon Bjornson
• Black Cliffs Counseling PLLC
• Dollie L Black
• Elizabeth Ashley Black, MD
• Lindsay M Black, PHARMD
• Loren Orion Black, MD MBA

• Dentist in Boise, ID
• Providers in Boise, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.