NPIMap

Organization Active NPI

Dentistry '4' Children PLLC

  • Dentist
  • Lewiston, ID
National Provider Identifier
1902896772
Registry record updated Dec 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D3494 Issued in ID
Legal business name
DENTISTRY '4' CHILDREN PLLC
Practice address
3326 4TH St
Suite 4
Lewiston, ID 83501-4455
Phone
(208) 743-2505
Fax
(208) 746-6395
NPI assigned
Oct 24, 2005
Last updated
Dec 2, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2010

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

Authorized official

Name
Ms. Laurie Lester
Title
Office Manager
Phone
(208) 743-2505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D3494 ID Primary

Addresses

Primary practice location

3326 4TH St
Suite 4
Lewiston, ID 83501-4455

Mailing address

3326 4TH St
Suite 4
Lewiston, ID 83501-4455
Phone (208) 743-2505

Other identifiers 2

IdentifierTypeStateIssuer
806332400MedicaidID
806496000MedicaidID

Other names 1

  • Dr Jeremy Wiggins Other name

National Provider Directory

National Provider Directory

Locations

3326 4th St
Ste 4
Lewiston, ID 83501
Phone (208) 743-2505

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291248000000",
    "number": "1902896772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3326 4TH ST",
            "address_2": "SUITE 4",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014455",
            "telephone_number": "208-743-2505",
            "fax_number": "208-746-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3326 4TH ST",
            "address_2": "SUITE 4",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014455",
            "telephone_number": "208-743-2505",
            "fax_number": "208-746-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTISTRY '4' CHILDREN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2010-12-02",
        "status": "A",
        "authorized_official_last_name": "LESTER",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-743-2505",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806332400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806496000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Jeremy Wiggins",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lewiston, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; 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.