Active NPI
Trista E Pottenger, DMD
- General Practice Dentistry
- Boise, ID
National Provider Identifier
1942641246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D4728
- Practice address
- 12212 W Amity Rd
Boise, ID 83709-5389 - Phone
- (208) 343-4732
- Fax
- (082) 343-3818
- NPI assigned
- Jul 15, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019030151 | IL | |
| Dentist | 122300000X | DS039643 | PA | |
| General Practice Dentistry | 1223G0001X | D4728 | ID | Primary |
Addresses
Primary practice location
12212 W Amity Rd
Boise, ID 83709-5389
Mailing address
12212 W Amity Rd
Boise, ID 83709-5389
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019030151 | IL | MD | Dentist |
| DS039643 | PA | MD | Dentist |
| D4728 | ID | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trista E Pottenger, DMD PLLC | Current | Accepting new patients | |
| Windy City Anesthesia PC | Past | Accepting new patients | |
| Matthew G. Fethke, D.D.S.,PC | General Practice | Past | Accepting new patients |
Locations
12212 W Amity Rd
Boise, ID 83709
Phone (208) 343-4732
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba High Desert Dental
- General Practice Dentistry
- Boise, ID
- NPI 1841450889
-
- Certified Registered Nurse Anesthetist
- Wentzville, MO
- NPI 1447514377
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635897600000",
"number": "1942641246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12212 W AMITY RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837095389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12212 W AMITY RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837095389",
"telephone_number": "208-343-4732",
"fax_number": "082-343-3818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTENGER",
"first_name": "TRISTA",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-15",
"last_updated": "2021-11-03",
"certification_date": "2021-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019030151",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS039643",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D4728",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.