Active NPI
John R Ukich, D.D.S.
- Pediatric Dentistry
- Coeur d'Alene, ID
National Provider Identifier
1972657922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- D3742
- Practice address
- 1717 Lincoln Way
Suite 205
Coeur D Alene, ID 83814-2556 - Phone
- (208) 667-3556
- Fax
- (208) 664-6814
- NPI assigned
- Jan 23, 2007
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | D3742 | ID | Primary |
Addresses
Primary practice location
1717 Lincoln Way
Suite 205
Coeur D Alene, ID 83814-2556
Mailing address
1492 E Twistwood Dr
Hayden Lake, ID 83835-7258
Phone (208) 667-3556
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 |
|---|---|---|---|
| D3742 | ID | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John M Ukich, DDS,PA | Pediatric Dentistry | Past | Accepting new patients |
Interoperability endpoints
- jukich627507@direct.multicare.org
Organizations & group practices 1
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 Pediatric Dental Center of North Idaho
- Pediatric Dentistry
- Coeur d'Alene, ID
- NPI 1295906063
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1972657922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1492 E TWISTWOOD DR",
"city": "HAYDEN LAKE",
"state": "ID",
"postal_code": "838357258",
"telephone_number": "208-667-3556",
"fax_number": "208-664-6814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 LINCOLN WAY",
"address_2": "SUITE 205",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142556",
"telephone_number": "208-667-3556",
"fax_number": "208-664-6814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UKICH",
"first_name": "JOHN",
"middle_name": "R",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "ID",
"license": "D3742",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur d'Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.