Pediatric Dentistry Associates

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D-1703 Issued in ID

Legal business name

PEDIATRIC DENTISTRY ASSOCIATES

Practice address

13014 W Persimmon LN
Boise, ID 83713-1986

Phone

(208) 377-2072

NPI assigned

Nov 2, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Rodman O Emory, D.D.S.NPI 1427012046

Title

President/Pediatric Dentist

Phone

(208) 377-2072

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rodman Owen Emory, D.D.S.

  • Pediatric Dentistry
  • Boise, ID
  • NPI 1427012046
  NPD (past) Authorized official

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

{
    "created_epoch": "1257120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257120000000",
    "number": "1851627467",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-02",
        "last_updated": "2009-11-02",
        "status": "A",
        "authorized_official_last_name": "EMORY",
        "authorized_official_first_name": "RODMAN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT/PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "208-377-2072",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D-1703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002697900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theresa Michele Pecsek, PMHNP-BC
• Rachael L Pedersen, NP
• Ryan Pedersen, L.AC., D.O.M.
• Elisabeth Pederson, LPC
• Pediatric Cardiology of Idaho
• Pediatric Neurosurgry of Idaho PC
• Pediatric Surgery of Idaho
• Ariane Diola Pedida
• Peer Recovery Supports of Idaho
• Weston Peine, DO

• Dental Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; 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.