IKDO FRUITLAND LLC NPI 1184108706

NPI Information

  • NPI: 1184108706
  • Provider Name: IKDO FRUITLAND LLC
  • Classification: Dentist - 1223P0221X
  • Specialization: Pediatric Dentistry
  • Entity Type: Organization
  • Doing Business As: IDAHO KIDS DENTISTRY & ORTHODONTICS FRUITLAND
  • Address: 1619 N WHITLEY DR
    FRUITLAND, ID
    ZIP 83619
  • Phone: (208) 452-4444

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NPI Details

IKDO FRUITLAND LLC is a pediatric dentistry dentist in Fruitland, 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 FRUITLAND LLC NPI is 1184108706. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Idaho Kids Dentistry & Orthodontics Fruitland.

The provider's business location address is:

1619 N WHITLEY DR
FRUITLAND, ID
ZIP 83619-162
Phone: (208) 452-4444
Fax: (208) 452-3322

The provider's authorized official is Michael D Payne .
The authorized official title is President and has the following contact phone number (208) 371-4445.

The enumeration date for this NPI number is 9/19/2018 and was last updated on 4/16/2019.

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
11223X0400XDentistOrthodontics and Dentofacial OrthopedicsNo
21223P0221XDentistPediatric DentistryYes

What is NPI?

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This page was last updated on: 11/21/2025

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