TRADEMARK DENTAL NPI 1861793796

NPI Information

NPI: 1861793796
Provider Name: TRADEMARK DENTAL
Classification: Dentist - 1223G0001X
Specialization: General Practice
Entity Type: Organization
Address: 115 N. PLYMOUTH AVE.
NEW PLYMOUTH, ID
ZIP 83655
Phone: (208) 278-9900

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NPI Details

TRADEMARK DENTAL is a general practice dentist in New Plymouth, ID. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. TRADEMARK DENTAL NPI is 1861793796. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

115 N. PLYMOUTH AVE.
NEW PLYMOUTH, ID
ZIP 83655
Phone: (208) 278-9900

The provider's authorized official is Tyler Robb .
The authorized official title is Owner and has the following contact phone number (208) 278-9900.

The enumeration date for this NPI number is 11/9/2010 and was last updated on 11/9/2010.

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	1223G0001X	Dentist	General Practice	D9152	OREGON	No
2	1223G0001X	Dentist	General Practice	D4158	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	1164682704	OTHER		PERSONAL NPI
2	9211402	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: 11/21/2025

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