Chubbuck Kidz Dental PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CHUBBUCK KIDZ DENTAL PC

Practice address

371 E Chubbuck Rd
Chubbuck, ID 83202

Phone

(208) 358-8871

NPI assigned

Aug 17, 2023

Last updated

Aug 18, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Magdalena Evans

Title

Sr. Credentialing Specialist

Phone

(720) 272-7558

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692316800000",
    "number": "1801679287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "371 E CHUBBUCK RD",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "83202",
            "telephone_number": "208-425-7690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 E CHUBBUCK RD",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "83202",
            "telephone_number": "208-358-8871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHUBBUCK KIDZ DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-17",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MAGDALENA",
        "authorized_official_title_or_position": "SR. CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "720-272-7558"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Childrens Supportive Services Incorporated
• Childrens Supportive Services Incorporated
• Elijah Chuang, LPC
• Chubbuck Chiropractic PA
• Chubbuck Fire Department
• Jan Fisher Clark, LPC
• Aaron Clayson, AG-NP
• Clifford Family Medicine
• Elisabeth Clonts
• Jeanna Chay Colborn, MA, SE

• Pediatric Dentistry in Chubbuck, ID
• Providers in Chubbuck, ID by specialty
• Pediatric Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.