NPIMap

Individual provider Active NPI

Jeffrey K Davis, DDS

  • Pediatric Dentistry
  • Boise, ID
National Provider Identifier
1730197849
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
PD-3813 Issued in ID
Practice address
651 E Parkcenter Blvd
Boise, ID 83706-6575
Phone
(208) 384-9872
NPI assigned
Aug 4, 2006
Last updated
Apr 16, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X PD-3813 ID Primary

Addresses

Primary practice location

651 E Parkcenter Blvd
Boise, ID 83706-6575

Mailing address

651 E Parkcenter Blvd
Boise, ID 83706-6575
Phone (208) 384-9872

Other identifiers 5

IdentifierTypeStateIssuer
1615855OtherIDUNITED CONCORDIA INS.
20-3727531OtherIDIRS FEDERAL TAX ID#
6O183 (LETTER O)OtherIDBLUE CROSS OF IDAHO INS.
CS10530OtherIDID STATE BOARD OF PHARM
N-01893OtherIDID STATE BOARD OF DENTIST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PD-3813IDMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Ikdo South Meridian LLC Pediatric Dentistry PastSince May 10, 2020 Accepting new patients
Ikdo Fruitland LLC Pediatric Dentistry Past Accepting new patients
Ikdo Emmett LLC Pediatric Dentistry PastSince Nov 3, 2019 Accepting new patients
Aesthetic Smiles P LLC General Practice Past Accepting new patients
Ikdo Star LLC Pediatric Dentistry Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1730197849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 E PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066575",
            "telephone_number": "208-384-9872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 E PARKCENTER BLVD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837066575",
            "telephone_number": "208-384-9872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JEFFREY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "ID",
            "license": "PD-3813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INS.",
            "identifier": "1615855",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS FEDERAL TAX ID#",
            "identifier": "20-3727531",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO INS.",
            "identifier": "6O183 (LETTER O)",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ID  STATE BOARD OF PHARM",
            "identifier": "CS10530",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ID STATE BOARD OF DENTIST",
            "identifier": "N-01893",
            "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 Apr 16, 2025; 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.