NPIMap

Organization Active NPI

Kent J Allen/ Shannon Widmier

Doing business as Pheasant Cove Dental

  • General Practice Dentistry
  • Kimberly, ID
National Provider Identifier
1770769325
Registry record updated Jan 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D1767 Issued in CA
Legal business name
KENT J ALLEN/ SHANNON WIDMIER
Doing business as
Pheasant Cove Dental
Practice address
702 Center St W
Kimberly, ID 83341
Phone
(208) 423-6444
Fax
(208) 423-6903
NPI assigned
Jan 14, 2008
Last updated
Jan 14, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2008

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

Authorized official

Name
Dr. Kent J Allen, D.D.S.NPI 1407954191
Title
Owner
Phone
(208) 423-6444

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
General Practice Dentistry 1223G0001X D1767 CA Primary

Addresses

Primary practice location

702 Center St W
Kimberly, ID 83341

Mailing address

702 Center Street West
PO Box B
Kimberly, ID 83341
Phone (208) 423-6444

Other identifiers 2

IdentifierTypeStateIssuer
000876700MedicaidID
9201818OtherIDSMILES

Other names 1

  • PHEASANT COVE DENTAL Doing business as

National Provider Directory

National Provider Directory

Locations

702 Center St W
Kimberly, ID 83341
Phone (208) 423-6444

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1770769325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 CENTER STREET WEST",
            "address_2": "PO BOX B",
            "city": "KIMBERLY",
            "state": "ID",
            "postal_code": "83341",
            "telephone_number": "208-423-6444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 CENTER ST W",
            "city": "KIMBERLY",
            "state": "ID",
            "postal_code": "83341",
            "telephone_number": "208-423-6444",
            "fax_number": "208-423-6903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT J ALLEN/ SHANNON WIDMIER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-423-6444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "D1767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000876700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMILES",
            "identifier": "9201818",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHEASANT COVE DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kimberly, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.