NPIMap

Organization Active NPI

Boise Toothtown Dentistry for Kids PLLC

  • Pediatric Dentistry
  • Boise, ID
National Provider Identifier
1780037705
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D4186PD Issued in ID
Legal business name
BOISE TOOTHTOWN DENTISTRY FOR KIDS PLLC
Practice address
13014 W Persimmon LN
Boise, ID 83713-1986
Phone
(208) 377-2072
Fax
(208) 376-7580
NPI assigned
Jul 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

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

Authorized official

Name
Dr. Dennis Garth Stoddard, DMD
Title
Owner
Phone
(208) 453-6188

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D4031 ID
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X D4186PD ID Primary

Addresses

Primary practice location

13014 W Persimmon LN
Boise, ID 83713-1986

Mailing address

13014 W Persimmon LN
Boise, ID 83713-1986
Phone (208) 377-2072

National Provider Directory

National Provider Directory

Locations

13014 W Persimmon Ln
Boise, ID 83713
Phone (208) 377-2072

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": "1468454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1780037705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13014 W PERSIMMON LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131986",
            "telephone_number": "208-377-2072",
            "fax_number": "208-376-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13014 W PERSIMMON LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131986",
            "telephone_number": "208-377-2072",
            "fax_number": "208-376-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE TOOTHTOWN DENTISTRY FOR KIDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "STODDARD",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "GARTH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-453-6188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4031",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "ID",
            "license": "D4186PD",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jul 14, 2016; 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.