SOUTHEAST IDAHO ORTHODONTICS, PLLC
NPI 1508080599
Dentist - Orthodontics and Dentofacial Orthopedics in Pocatello, ID

Active since April 12, 2007
625 E ALAMEDA RD, POCATELLO, ID 83201(208) 237-0005(208) 237-7982 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Southeast Idaho Orthodontics, Pllc NPPES

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

SOUTHEAST IDAHO ORTHODONTICS, PLLC (NPI 1508080599) is a healthcare organization registered as an orthodontics and dentofacial orthopedics in Pocatello, Idaho and active in the NPI registry since April 2007. The organization lists Eric D Johnson, Owner, as its authorized official.

NPPES Registry Identity

NPI1508080599
Entity TypeOrganization
Primary Taxonomy1223X0400X
Legal Business NameSOUTHEAST IDAHO ORTHODONTICS, PLLC
Location Address625 E ALAMEDA RDPocatello, ID 83201-3622
Mailing Address625 E Alameda RdPocatello, ID 83201-3622 · (208) 237-0005 · Fax (208) 237-7982
Fax(208) 237-7982
Organization SubpartNo
Authorized OfficialEric D JohnsonOwner · (208) 237-0005
Enumeration DateApril 12, 2007
Last NPPES UpdateAugust 22, 2020
NPI 1508080599 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentist · Orthodontics and Dentofacial OrthopedicsDental Providers
Taxonomy Code1223X0400X
Definition
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.
625 E ALAMEDA RD, Pocatello, ID 83201

Other Identifiers 1

Medicaid8042938ID

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 7

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

Dentist (Orthodontics and Dentofacial Orthopedics)
625 E ALAMEDA RD
POCATELLO, ID 83201
Dentist (Pediatric Dentistry)
625 E ALAMEDA RD
POCATELLO, ID 83201
Dentist (Pediatric Dentistry)
625 E ALAMEDA RD
POCATELLO, ID 83201
Dentist (Pediatric Dentistry)
625 E ALAMEDA RD
POCATELLO, ID 83201
Dentist (Orthodontics and Dentofacial Orthopedics)
625 E ALAMEDA RD
POCATELLO, ID 83201
Dentist (Orthodontics and Dentofacial Orthopedics)
625 E ALAMEDA RD
POCATELLO, ID 83201
Dentist (Orthodontics and Dentofacial Orthopedics)
625 E ALAMEDA RD
POCATELLO, ID 83201

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 Southeast Idaho Orthodontics, PLLC's NPI number?

The NPI number for Southeast Idaho Orthodontics, PLLC is 1508080599. It was assigned to this organization in the NPPES registry on April 12, 2007.

Where is Southeast Idaho Orthodontics, PLLC located?

Southeast Idaho Orthodontics, PLLC is located at 625 E Alameda Rd, Pocatello, ID 83201. The listed phone number is (208) 237-0005.

What is Southeast Idaho Orthodontics, PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Orthodontics and Dentofacial Orthopedics, with taxonomy code 1223X0400X.

When was this NPI record last updated?

The NPPES record for Southeast Idaho Orthodontics, PLLC was last updated on August 22, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.