IKDO SOUTH MERIDIAN LLC NPI 1174145684

NPI Information

NPI: 1174145684
Provider Name: IKDO SOUTH MERIDIAN LLC
Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

Address:
3839 E AMITY RD
MERIDIAN, ID
ZIP 83642
Phone: (208) 999-4999
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IKDO SOUTH MERIDIAN LLC is a pediatric dentistry dentist in Meridian, ID. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. IKDO SOUTH MERIDIAN LLC NPI is 1174145684. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3839 E AMITY RD
MERIDIAN, ID
ZIP 83642
Phone: (208) 999-4999

The provider's authorized official is Michael D Payne .
The authorized official title is Owner and has the following contact phone number (208) 884-4466.

The enumeration date for this NPI number is 5/7/2020 and was last updated on 5/7/2020.

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	1223X0400X	Dentist	Orthodontics and Dentofacial Orthopedics			No
2	1223P0221X	Dentist	Pediatric Dentistry			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: 11/14/2023

NPI Synchronization or Removal

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