LINEBERRY ORTHODONTICS NPI 1154562783

NPI Information

NPI: 1154562783
Provider Name: LINEBERRY ORTHODONTICS
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
13059 W PERSIMMON LN
BOISE, ID
ZIP 83713
Phone: (208) 658-9470
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LINEBERRY ORTHODONTICS is a dental clinic center in Boise, ID. LINEBERRY ORTHODONTICS NPI is 1154562783. The provider is registered as an organization entity type.

The provider's business location address is:

13059 W PERSIMMON LN
BOISE, ID
ZIP 83713-986
Phone: (208) 658-9470
Fax: (208) 658-0778

The provider's authorized official is Laura Lineberry .
The authorized official title is Orthodontist and has the following contact phone number (208) 658-9470.

The enumeration date for this NPI number is 3/11/2009 and was last updated on 3/11/2009.

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	261QD0000X	Clinic/Center	Dental	D3184OR	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8053305	MEDICAID	IDAHO

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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