Paventy Harrison Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D-4386 Issued in ID

Legal business name

PAVENTY HARRISON DENTAL LLC

Practice address

1675 W Hill Rd
Boise, ID 83702-0982

Phone

(509) 475-5367

NPI assigned

Oct 17, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Timothy Carl Paventy, DDS

Title

Owner

Phone

(509) 475-5367

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508198400000",
    "number": "1972014983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 W HILL RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837020982",
            "telephone_number": "509-475-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 W HILL RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837020982",
            "telephone_number": "509-475-5367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVENTY HARRISON DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A",
        "authorized_official_last_name": "PAVENTY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-475-5367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D-4386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Boise, ID
• Providers in Boise, 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 Oct 17, 2017; 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.