Southern Springs Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3807 Issued in ID

Legal business name

SOUTHERN SPRINGS DENTAL PLLC

Practice address

1910 S Meridian Rd
Ste 150
Meridian, ID 83642-9061

Phone

(208) 888-3540

NPI assigned

Jun 9, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Barry W Jardine, DMDNPI 1992838627

Title

Owner Dentist

Phone

(208) 888-3540

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Barry Wayne Jardine, D.M.D

  • General Practice Dentistry
  • Meridian, ID
  • NPI 1992838627
  NPD (past) Authorized official
• Kendall Elyse Walker, RDH

  • Dental Hygienist
  • Meridian, ID
  • NPI 1396425864
  NPD (past)

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1730348236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 S MERIDIAN RD",
            "address_2": "STE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-888-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 S MERIDIAN RD",
            "address_2": "STE 150",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836429061",
            "telephone_number": "208-888-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SPRINGS DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "JARDINE",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "208-888-3540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807969400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Garry Southard, M.D.
• Southern Idaho Family Medicine PLLC
• Southern Idaho Health Partners Dba Saltzer Clinics
• Southern Idaho Health Partners LLC
• Southern Idaho Surgery Center PLLC
• Ashley Southern, NMD
• Sydney Lenz Southern
• James P Souza, MD
• Kendall Kristine Sower, MS
• Michael Bryon Spackman, MD

• General Practice Dentistry in Meridian, ID
• Providers in Meridian, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.