Southridge Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3499 Issued in ID

Legal business name

SOUTHRIDGE DENTAL

Practice address

2811 12TH Ave Rd
Nampa, ID 83686-8482

Phone

(208) 466-2458

Fax

(208) 465-6303

NPI assigned

Jun 9, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Robert Alan Pratt, DMD

Title

Dentist

Phone

(208) 466-2458

Specialties & licenses 1

Addresses

Tax ID family

Southridge Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southridge Dental

  • General Practice Dentistry
  • Nampa, ID
  • NPI 1003010877
  NPD tax ID

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1891954343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836868482",
            "telephone_number": "208-466-2458",
            "fax_number": "208-465-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836868482",
            "telephone_number": "208-466-2458",
            "fax_number": "208-465-6303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHRIDGE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "PRATT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-466-2458",
        "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": "D-3499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soul Care Counseling and Consulting, LLC
• Sound Sleep Medical LLC
• Southern Idaho Health Partners Dba Saltzer Clinics
• Janie Southern, CRT
• Southridge Dental
• Virginia Spackman, M.ED, LCPC
• Kari Paynter Spaete, AUD
• Christina Spangberg, PHYSICAL THERAPIST
• Shelby Ann Spangler, LCPC
• Sparhawk Vision, CHTD

• General Practice Dentistry in Nampa, ID
• Providers in Nampa, 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 18, 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.