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SOUTHRIDGE DENTAL
NPI 1003010877
Dentist - General Practice in Nampa, ID

Active since June 13, 2007
2811 12TH AVE RD, NAMPA, ID 83686(208) 466-2458(208) 465-6303 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southridge Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHRIDGE DENTAL (NPI 1003010877) is a healthcare organization registered as a general practice in Nampa, Idaho and active in the NPI registry since June 2007. The organization lists Robert Alan Pratt, Dentist, as its authorized official.

NPPES Registry Identity

NPI1003010877
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameSOUTHRIDGE DENTAL
Location Address2811 12TH AVE RDNampa, ID 83686-8482
Mailing Address2811 12th Ave RdNampa, ID 83686-8482 · (208) 466-2458 · Fax (208) 465-6303
Phone(208) 466-2458
Fax(208) 465-6303
Organization SubpartNo
Authorized OfficialRobert Alan PrattDentist · (208) 466-2458
Enumeration DateJune 13, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1003010877 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in ID · D3499
Definition
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.
2811 12TH AVE RD, Nampa, ID 83686
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TODD SQUIRES DDS
Dentist (General Practice)
2811 12TH AVE RD
NAMPA, ID 83686
Canyon County (208) 466-2458
SLEEP RIGHT IDAHO PLLC
Dentist (General Practice)
2811 12TH AVE RD
NAMPA, ID 83686
Canyon County (208) 466-2458
TODD L SQUIRES DDC PLLC
Dentist (General Practice)
2811 12TH AVE RD
NAMPA, ID 83686
Canyon County (208) 466-2458
KELLY E. CARLEN, DDS PLLC
Clinic/Center (Dental)
2811 12TH AVE RD
NAMPA, ID 83686
Canyon County (208) 461-1060
SOUTHRIDGE DENTAL
Dentist (General Practice)
2811 12TH AVE RD
NAMPA, ID 83686
Canyon County (208) 466-2458
DR. SHAWN D LEE D.M.D.
Dentist (General Practice)
2811 12TH AVE RD
NAMPA, ID 83686
Canyon County (208) 466-2458

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southridge Dental's NPI number?

The NPI number for Southridge Dental is 1003010877. It was assigned to this organization in the NPPES registry on June 13, 2007.

Where is Southridge Dental located?

Southridge Dental is located at 2811 12th Ave Rd, Nampa, ID 83686. The listed phone number is (208) 466-2458.

What is Southridge Dental's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Southridge Dental was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.