Club 32 Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CLUB 32 DENTAL

Practice address

624 3Rd St S
Nampa, ID 83651-3840

Phone

(208) 466-2456

Fax

(208) 318-0227

NPI assigned

Aug 5, 2020

Organization subpart

No

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

Authorized official

Name

Kim Benson Keller, DDS

Title

Owner

Phone

(208) 505-8586

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1720698608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 3RD ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513840",
            "telephone_number": "208-505-8586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 3RD ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513840",
            "telephone_number": "208-466-2456",
            "fax_number": "208-318-0227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB 32 DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-05",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "BENSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-505-8586",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonna Clayton
• Clearwater Dental PLLC
• Alain Murhula Clements
• David H Clements, PA-C
• Mark B Clinger, MD - FAMILY PRACTICE
• Coached by Cassi LLC
• Lillian Katherine Cobb
• Sara Jennifer Cobb
• Michael A Codina, MD
• Samantha Lynn Colbert

• Dental Clinic/Center in Nampa, ID
• Providers in Nampa, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; 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.