Edgewater Dental

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

3315 Issued in ID

Legal business name

EDGEWATER DENTAL

Practice address

1436 S Edgewater Cir
Nampa, ID 83686

Phone

(208) 463-9600

Fax

(208) 461-3156

NPI assigned

Apr 1, 2008

Organization subpart

No

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

Authorized official

Name

Rhonda Milich

Title

Receptionist

Phone

(208) 463-9600

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1891967659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1436 S EDGEWATER CIR",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836865051",
            "telephone_number": "208-463-9600",
            "fax_number": "208-461-3156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 S EDGEWATER CIR",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "83686",
            "telephone_number": "208-463-9600",
            "fax_number": "208-461-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWATER DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-01",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "MILICH",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "RECEPTIONIST",
        "authorized_official_telephone_number": "208-463-9600"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "ID",
            "license": "3315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO SMILES",
            "identifier": "9201655",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Health Maintenance Organization in Nampa, ID
• Providers in Nampa, ID by specialty
• Health Maintenance Organization in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.