Ikdo State Street LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

IKDO STATE STREET LLC

Practice address

9209 W State St
Garden City, ID 83714

Phone

(208) 388-1111

NPI assigned

Sep 18, 2018

Organization subpart

No

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

Authorized official

Name

Jaycie Birch

Title

Office Manager

Phone

(208) 388-1111

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Jason Porter

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Sunnyside, WA
  • NPI 1003272444
  NPD (past)

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537228800000",
    "number": "1932683752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9209 W STATE ST",
            "city": "GARDEN CITY",
            "state": "ID",
            "postal_code": "83714",
            "telephone_number": "208-388-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9209 W STATE ST",
            "city": "GARDEN CITY",
            "state": "ID",
            "postal_code": "83714",
            "telephone_number": "208-388-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IKDO STATE STREET LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-18",
        "last_updated": "2018-09-18",
        "status": "A",
        "authorized_official_last_name": "BIRCH",
        "authorized_official_first_name": "JAYCIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-388-1111"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Health Services Wyoming LLC (Miracle Ear)
• Daniel Heath, DC
• Elizabeth Hinkle, DPT
• Julia Eden Hummer, LPC
• Ida-Ore Planning & Development Association, Inc. (Idaho Council of Governments/ Area Agency on Aging)
• Imperial Transport LLC
• Imperial Transport LLC
• Issaura Potter, LLC
• Michael Jackson
• Jeppe Chiropractic PLLC

• Orthodontics and Dentofacial Orthopedics Dentistry in Garden City, ID
• Providers in Garden City, ID by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; 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.