RANDY DEMETTER DDS NPI 1275941288

NPI Information

NPI: 1275941288
Provider Name: RANDY DEMETTER, DDS
Classification: Dentist - 1223P0300X
Entity Type: Individual

Specialization: Periodontics

PECOS Registration: Yes

Address:
140 E BOISE AVE
BOISE, ID
ZIP 83706
Phone: (208) 385-9228
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Randy Demetter, DDS is a periodontics dentist in Boise, ID. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. Randy Demetter, DDS NPI is 1275941288. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

140 E BOISE AVE
BOISE, ID
ZIP 83706-302
Phone: (208) 385-9228

The NPI 1275941288 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS).

The enumeration date for this NPI number is 7/23/2014 and was last updated on 4/5/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0300X	Dentist	Periodontics	ETN283	TEXAS	No
2	1223P0300X	Dentist	Periodontics	D-4831-PE	IDAHO	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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