NPIMap

Organization Active NPI

Idaho Dental Professionals, P.C.

Doing business as South Corner Dental Care

  • General Practice Dentistry
  • Meridian, ID
National Provider Identifier
1982442448
Registry record updated Jul 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
IDAHO DENTAL PROFESSIONALS, P.C.
Doing business as
South Corner Dental Care
Practice address
4701 S Eagle Rd. Ste. 100
Meridian, ID 83642-7563
Phone
(208) 900-3350
Fax
(208) 900-3425
NPI assigned
Jul 18, 2024
Last updated
Jul 18, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
IDAHO DENTAL PROFESSIONALS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 18, 2024

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

Authorized official

Name
Cemyira McDougal
Title
Credentialing Coordinator
Phone
(217) 764-8609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

4701 S Eagle Rd. Ste. 100
Meridian, ID 83642-7563

Mailing address

4701 S Eagle Rd. Ste. 100
Meridian, ID 83642-7563
Phone (208) 900-3350

Other names 1

  • South Corner Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Idaho Dental Professionals PC9 organizations share this tax ID, including this one
Part of
Idaho Dental Professionals PC

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4701 S Eagle Rd
#100
Meridian, ID 83642
Phone (208) 900-3350

NPI Registry JSON

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

{
    "created_epoch": "1721260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721260800000",
    "number": "1982442448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 S EAGLE RD. STE. 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427563",
            "telephone_number": "208-900-3350",
            "fax_number": "208-900-3425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 S EAGLE RD. STE. 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427563",
            "telephone_number": "208-900-3350",
            "fax_number": "208-900-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IDAHO DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2024-07-18",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "MCDOUGAL",
        "authorized_official_first_name": "CEMYIRA",
        "authorized_official_title_or_position": "CREDENTIALING  COORDINATOR",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Corner Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; 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.