PEDIATRIC DENTISTRY ASSOCIATES NPI 1851627467

NPI Information

NPI: 1851627467
Provider Name: PEDIATRIC DENTISTRY ASSOCIATES
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
13014 W PERSIMMON LN
BOISE, ID
ZIP 83713
Phone: (208) 377-2072
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PEDIATRIC DENTISTRY ASSOCIATES is a dental clinic center in Boise, ID. PEDIATRIC DENTISTRY ASSOCIATES NPI is 1851627467. The provider is registered as an organization entity type.

The provider's business location address is:

13014 W PERSIMMON LN
BOISE, ID
ZIP 83713-986
Phone: (208) 377-2072

The provider's authorized official is Rodman O Emory .
The authorized official title is President/pediatric Dentist and has the following contact phone number (208) 377-2072.

The enumeration date for this NPI number is 11/2/2009 and was last updated on 11/2/2009.

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	D-1703	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	002697900	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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