NPIMap

Organization Active NPI

Kootenai Family Dental, PA

  • Dentist
  • Coeur Dalene, ID
National Provider Identifier
1942317664
Registry record updated Oct 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3794 Issued in ID
Legal business name
KOOTENAI FAMILY DENTAL, PA
Practice address
1420 Lincoln Way
Suite 200
Coeur Dalene, ID 83814
Phone
(208) 664-8283
Fax
(208) 667-0794
NPI assigned
Aug 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2008

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

Authorized official

Name
Dr. Robert L Wilder, DDS
Title
Dentist
Phone
(208) 664-8283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 3794 ID Primary

Addresses

Primary practice location

1420 Lincoln Way
Suite 200
Coeur Dalene, ID 83814

Mailing address

1420 Lincoln Way
Suite 200
Coeur Dalene, ID 83814
Phone (208) 664-8283

Other names 1

  • Kootenai Family Dental, PA Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223251200000",
    "number": "1942317664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 LINCOLN WAY",
            "address_2": "SUITE 200",
            "city": "COEUR DALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-664-8283",
            "fax_number": "208-667-0794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 LINCOLN WAY",
            "address_2": "SUITE 200",
            "city": "COEUR DALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-664-8283",
            "fax_number": "208-667-0794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOTENAI FAMILY DENTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2008-10-06",
        "status": "A",
        "authorized_official_last_name": "WILDER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-664-8283",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "3794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kootenai Family Dental, PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coeur Dalene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.