SMILES 4 KIDS BLACKFOOT PLLC (NPI# 1154799047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154799047 |
| Entity Type | Organization |
| Organization Name | SMILES 4 KIDS BLACKFOOT PLLC |
| Other Organization Name | SMILES 4 KIDS |
| Practice Address |
621 Jensen Grove Dr Blackfoot ID 83221-1685 |
| Practice Telephone | 2087854696 |
| Mailing Telephone | 2087854696 |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |
| Authorized Official Name | DR. KORY D BINGHAM (MANAGING PARTNER) |
| Authorized Official Telephone | 2085293007 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Smiles 4 Kids | Doing Business As Name - Organization |
| Street Address |
621 JENSEN GROVE DR |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221-1685 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
| 1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
| 1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
| 1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
| Find all providers in zip 83221 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124657010 | Rigby Pediatric Dental Pllc | Dentist | 688 Rigby Lake Circle, Suite 4, Rigby, ID 83442 | 2020-04-03 |
| 1154805786 | Jmj Nampa LLC | Dentist | 914 12th Ave Rd, Nampa, ID 83686 | 2018-09-19 |
| 1932683752 | Ikdo State Street LLC | Dentist | 9209 W State St, Garden City, ID 83714 | 2018-09-18 |
| 1902325749 | Cherry Lane Kids Dentistry | Dentist | 1558 N Crestmont Dr Ste A, Meridian, ID 83642-2194 | 2017-09-13 |
| 1922462142 | Our Town Family Dentistry | Dentist | 39 W Idaho St, Weiser, ID 83672-1943 | 2016-04-13 |
| 1720447097 | Brock Coletti | Dentist | 3235 N Towerbridge Way Ste 200, Meridian, ID 83646-5721 | 2016-02-15 |
| 1982012498 | Dallin J. Dance | Dentist | 1027 W. Prairie Ave., Hayden, ID 83835 | 2014-07-28 |
| 1679812002 | Dentistry for Kids Pllc | Dentist | 625 E Alameda Rd., Pocatello, ID 83201 | 2013-02-05 |
| 1609106012 | Cordell Denton Nebeker | Dentist | 4111 Clocktower Ave., Caldwell, ID 83607 | 2010-01-07 |
| 1316192370 | A Childs Smile | Dentist | 3299 E. 17th Street, Ammon, ID 83406 | 2008-11-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.