SOUTHRIDGE DENTAL NPI 1003010877

Dentist (General Practice) in Nampa, ID

NPI 1003010877 Organization Dentist General Practice

About SOUTHRIDGE DENTAL

Southridge Dental is a provider established in Nampa, Idaho specializing in dentist (general practice) . The NPI number of Southridge Dental is 1003010877 and was assigned on June 2007. The practitioner's primary taxonomy code is 1223G0001X with license number D3499 (ID). The provider is registered as an organization and their NPI record was last updated one year ago. Southridge Dental operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Dr. Robert Alan Pratt D.m.d. (Dentist)

A dentist like Southridge Dental is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.

NPI

1003010877

Provider NameSOUTHRIDGE DENTAL
Provider Location Address2811 12TH AVE RD NAMPA, ID 83686
Provider Mailing Address2811 12TH AVE RD NAMPA, ID 83686
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date06-13-2007
Last Update Date08-22-2020


Primary Taxonomy

Taxonomy Code1223G0001X
ClassificationDentist
TypeDental Providers
SpecializationGeneral Practice
License No.D3499
License StateID
Taxonomy DescriptionA 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.

Business Address

SOUTHRIDGE DENTAL
2811 12TH AVE RD
NAMPA, ID
ZIP 83686
Phone: (208) 466-2458
Fax: (208) 465-6303

Get Directions


Mailing Address

SOUTHRIDGE DENTAL
2811 12TH AVE RD
NAMPA, ID
ZIP 83686
Phone: (208) 466-2458
Fax: (208) 465-6303



Authorized Official

Authorized Official NameDR. ROBERT ALAN PRATT D.M.D.
Authorized Official TitleDENTIST
Authorized Official Phone(208) 466-2458

Group Taxonomy


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

Other Providers at the same location


The following 8 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1053503573DR. KELLY E CARLEN DDS
Individual
Dentist2811 12TH AVE RD
NAMPA, ID 83686
(208) 461-1060
1689849598KELLY E. CARLEN, DDS PLLC
Organization
Clinic/Center (Dental)2811 12TH AVE RD
NAMPA, ID 83686
(208) 461-1060
1891954343SOUTHRIDGE DENTAL
Organization
Dentist (General Practice)2811 12TH AVE RD
NAMPA, ID 83686
(208) 466-2458
1962714139DR. SHAWN D LEE D.M.D.
Individual
Dentist (General Practice)2811 12TH AVE RD
NAMPA, ID 83686
(208) 466-2458
1437660388SLEEP RIGHT IDAHO PLLC
Organization
Dentist (General Practice)2811 12TH AVE RD
NAMPA, ID 83686
(208) 466-2458
1508816000DR. ROARKE JAKE MILLER DMD
Individual
Dentist (General Practice)2811 12TH AVE RD
NAMPA, ID 83686
(208) 466-2322
1457593584TODD L SQUIRES DDC PLLC
Organization
Dentist (General Practice)2811 12TH AVE RD
NAMPA, ID 83686
(208) 466-2458
1063894145 TODD SQUIRES DDS
Individual
Dentist (General Practice)2811 12TH AVE RD
NAMPA, ID 83686
(208) 466-2458

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.