Idaho Advanced Dental Anesthesia, LLC

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

Legal business name

IDAHO ADVANCED DENTAL ANESTHESIA, LLC

Practice address

1310 S Vista Ave Ste 21
Boise, ID 83705-2579

Phone

(208) 559-5518

NPI assigned

Jun 15, 2026

Last updated

Jun 15, 2026By 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

Dr. Jake Wood, DMDNPI 1073260311

Title

Owner

Phone

(801) 369-8569

Specialties & licenses 1

Addresses

Other names 1

• Idaho Dental Sedation Other name

Practitioners 1

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.

• Jake A Wood

  • Dental Anesthesiology
  • Meridian, ID
  • NPI 1073260311
  Authorized official Same address or phone

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

{
    "created_epoch": "1781481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1881529410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 S VISTA AVE STE 21",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837052579",
            "telephone_number": "208-559-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 S VISTA AVE STE 21",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837052579",
            "telephone_number": "208-559-5518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO ADVANCED DENTAL ANESTHESIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-15",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "JAKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-369-8569",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho Dental Sedation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Id PHS LLC
• Id SDS II PLLC (Super Smiles Orthodontics)
• Idacare (IdaCare Inc.)
• Idacare Foundation
• Idagem Services Inc
• Idaho Advanced Medical Care LLC
• Idaho Anesthesia Professionals LLC
• Idaho Behavior Change
• Idaho Behavioral Health, Inc.
• Idaho Behavioral Health, Inc.

• Dental Anesthesiology in Boise, ID
• Providers in Boise, ID by specialty
• Dental Anesthesiology in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; 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.