Ponderay Newco PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PONDERAY NEWCO PLLC

Practice address

476653 Highway 95 Ste 1
Ponderay, ID 83852-9816

Phone

(208) 265-6771

NPI assigned

Sep 15, 2026

Last updated

Sep 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. Kory Wilson, DDS

Title

Ceo

Phone

(208) 661-7879

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1789430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789430400000",
    "number": "1942111307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "476653 HIGHWAY 95 STE 1",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838529816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "476653 HIGHWAY 95 STE 1",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838529816",
            "telephone_number": "208-265-6771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDERAY NEWCO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-15",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-661-7879",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Ponderay, ID
• Providers in Ponderay, ID by specialty
• Dental Clinic/Center in Idaho

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