Active NPI
Mallard Family Dental Center, PLLC
- General Practice Dentistry
- Boise, ID
National Provider Identifier
1740375591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D1672
- Legal business name
- MALLARD FAMILY DENTAL CENTER, PLLC
- Practice address
- 144 E Mallard Dr
Boise, ID 83706-3975 - Phone
- (208) 342-0315
- NPI assigned
- Oct 4, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. James A. Gorczyca
- Title
- Owner
- Phone
- (208) 342-0315
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D1672 | ID | Primary |
Addresses
Primary practice location
144 E Mallard Dr
Boise, ID 83706-3975
Mailing address
144 E Mallard Dr
Boise, ID 83706-3975
Phone (208) 342-0315
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00001 0135725 | Other | ID | REGENCE BLUE SHILD |
| 66688 | Other | ID | BLUE CROSS |
| 6E730 | Other | ID | FEDERAL EMPLOYEE PROVIDER |
| 6E755 | Other | ID | FEDERAL EMPLOYEE PROVIDER |
National Provider Directory
National Provider DirectoryLocations
144 E Mallard Dr
Boise, ID 83706
Phone (208) 342-0315
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dentist
- Boise, ID
- NPI 1477622983
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1740375591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "144 E MALLARD DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837063975",
"telephone_number": "208-342-0315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "144 E MALLARD DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837063975",
"telephone_number": "208-342-0315"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MALLARD FAMILY DENTAL CENTER, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-04",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "GORCZYCA",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "208-342-0315",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D1672",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHILD",
"identifier": "00001 0135725",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "66688",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL EMPLOYEE PROVIDER",
"identifier": "6E730",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL EMPLOYEE PROVIDER",
"identifier": "6E755",
"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 Aug 22, 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.