NPIMap

Organization Active NPI

Babichenko Dental Lab

  • Denturist
  • Boise, ID
National Provider Identifier
1770623910
Registry record updated Aug 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DenturistTaxonomy code 122400000X
License
LD44 Issued in ID
Legal business name
BABICHENKO DENTAL LAB
Practice address
10480 W Garverdale CT
Suite 804B
Boise, ID 83704-5411
Phone
(208) 376-6613
Fax
(208) 376-6613
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2008

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

Authorized official

Name
Mr. Gennady S Babichenko, LDNPI 1629115761
Title
Owner
Phone
(208) 376-6613

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)CodeLicenseStatePrimary
DenturistGroup: 193400000X SINGLE SPECIALTY GROUP 122400000X LD44 ID Primary

Addresses

Primary practice location

10480 W Garverdale CT
Suite 804B
Boise, ID 83704-5411

Mailing address

10480 W Garverdale CT
Suite 804B
Boise, ID 83704-5411
Phone (208) 376-6613

Other identifiers 1

IdentifierTypeStateIssuer
806208700MedicaidID

Other names 1

  • European Denture Center Doing business as

National Provider Directory

National Provider Directory

Locations

10480 W Garverdale Ct
Ste 804B
Boise, ID 83704
Phone (208) 376-6613

Practitioners & affiliated clinicians

Practitioners 2

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": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218153600000",
    "number": "1770623910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10480 W GARVERDALE CT",
            "address_2": "SUITE 804B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045411",
            "telephone_number": "208-376-6613",
            "fax_number": "208-376-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10480 W GARVERDALE CT",
            "address_2": "SUITE 804B",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045411",
            "telephone_number": "208-376-6613",
            "fax_number": "208-376-6613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BABICHENKO DENTAL LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2008-08-08",
        "status": "A",
        "authorized_official_last_name": "BABICHENKO",
        "authorized_official_first_name": "GENNADY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-376-6613",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LD"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Denturist",
            "state": "ID",
            "license": "LD44",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806208700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "European Denture Center",
            "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 Aug 8, 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.