Matthew G. Fethke, D.D.S.,PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3413 Issued in ID

Legal business name

MATTHEW G. FETHKE, D.D.S.,PC

Doing business as

High Desert Dental

Practice address

12212 W Amity Rd
Boise, ID 83709-5389

Phone

(208) 343-4732

Fax

(208) 343-3818

NPI assigned

Jun 12, 2008

Last updated

Jun 12, 2008By 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

Janet D Hefner

Title

Office Manager

Phone

(208) 343-4732

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• High Desert Dental Doing business as

Practitioners 2

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.

• Matthew G. Fethke, D.D.S.

  • General Practice Dentistry
  • Boise, ID
  • NPI 1447343488
  NPD (past)
• Trista E Pottenger, DMD

  • General Practice Dentistry
  • Boise, ID
  • NPI 1942641246
  NPD (past)

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1841450889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12212 W AMITY RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837095389",
            "telephone_number": "208-343-4732",
            "fax_number": "208-343-3818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12212 W AMITY RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837095389",
            "telephone_number": "208-343-4732",
            "fax_number": "208-343-3818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW G. FETHKE, D.D.S.,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-12",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "HEFNER",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-343-4732"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1447343488",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "High Desert Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Victorie Dawn Mattei, LPC, CRC
• Matter and Spirit Counseling Services, LLC
• Brian D Matteson, M.D.
• Nathan David Matteson
• Matthew D Pitcher, DO PLLC
• Matthew R Sericati, M.D. Chartered
• Matthew S. Murphy (House of Hearing Audiology Clinic)
• Matthew Tuft Dental LLC (Copperstone Dental)
• Indu Liz Matthew, M.D.
• Brittany Matthews, FNP-BC

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.