NPIMap

Organization Active NPI

Idaho Dental Professionals, P.C.

  • General Practice Dentistry
  • Boise, ID
National Provider Identifier
1760162812
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
IDAHO DENTAL PROFESSIONALS, P.C.
Practice address
1578 S Timesquare LN
Boise, ID 83709-8266
Phone
(208) 321-1141
NPI assigned
Jul 24, 2023
Organization subpart
Yes
Parent organization
IDAHO DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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

Authorized official

Name
Cemyira McDougal
Title
Credentialing Coordinator
Phone
(217) 764-8609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1578 S Timesquare LN
Boise, ID 83709-8266

Mailing address

1578 S Timesquare LN
Boise, ID 83709-8266

Other names 1

  • Dayley Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Idaho Dental Professionals PC9 organizations share this tax ID, including this one
Part of
Idaho Dental Professionals PC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1578 S Timesquare Ln
Boise, ID 83709
Phone (208) 321-1141

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1760162812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1578 S TIMESQUARE LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837098266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1578 S TIMESQUARE LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837098266",
            "telephone_number": "208-321-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IDAHO DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2023-07-24",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A",
        "authorized_official_last_name": "MCDOUGAL",
        "authorized_official_first_name": "CEMYIRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dayley Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 24, 2023; 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.