IKDO FRUITLAND LLC (NPI# 1184108706) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184108706 |
| Entity Type | Organization |
| Organization Name | IKDO FRUITLAND LLC |
| Other Organization Name | IDAHO KIDS DENTISTRY & ORTHODONTICS FRUITLAND |
| Practice Address |
1619 N Whitley Dr Fruitland ID 83619-2162 |
| Mailing Address |
3289 N Towerbridge Way Meridian ID 83646-8347 |
| Practice Telephone | 2084524444 |
| Practice Fax Number | 2084523322 |
| Mailing Telephone | 2088844466 |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2019-04-16 |
| Authorized Official Name | DR. MICHAEL D PAYNE (PRESIDENT) |
| Authorized Official Telephone | 2083714445 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers | ||
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Idaho Kids Dentistry & Orthodontics Fruitland | Doing Business As Name - Organization |
| Street Address |
1619 N WHITLEY DR |
| City | FRUITLAND |
| State | ID |
| Zip Code | 83619-2162 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992322382 | Dallin Scott Wilkes | Physical Therapist | 2175 N Whitley Dr., Fruitland, ID 83619 | 2020-07-01 |
| 1659925113 | Treasure Valley Classical Academy | Local Education Agency (LEA) | 500 Sw 3rd Street, Fruitland, ID 83619 | 2019-08-01 |
| 1083146559 | Total Renal Care, Inc. | Clinic/Center | 815 Nw 13th St, Fruitland, ID 83619 | 2017-04-03 |
| 1154563948 | Becky Jean Wolery | Social Worker | 910 Nw 16th St Ste 101, Fruitland, ID 83619 | 2009-03-25 |
| 1740426196 | John Wesley Linhart | Physical Therapist | 1116 Nw 16th Street, Fruitland, ID 83619 | 2009-01-06 |
| 1528263670 | Snake River Dermatology, Pa | Dermatology | 1611 N Whitley Dr, #7, Fruitland, ID 83619 | 2007-06-19 |
| 1568591204 | John Linton Close | Registered Nurse | 1509 N Whitley Drive, Suite 5, Fruitland, ID 83619 | 2007-03-05 |
| 1629110671 | Payette School Dist #373 | Local Education Agency (LEA) | 303 Sw 3rd Street, Fruitland, ID 83619 | 2007-02-13 |
| 1912075839 | William Frederick Martsch | Dentist | 315 N. Whitley, Fruitland, ID 83619 | 2006-11-30 |
| 1992880132 | Ryan David Hillam | Dentist | 1820 N.whitley Drive, Fruitland, ID 83619 | 2006-10-26 |
| Find all providers in zip 83619 | ||||
| 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 |
| 1154799047 | Smiles 4 Kids Blackfoot Pllc | Dentist | 621 Jensen Grove Dr, Blackfoot, ID 83221-1685 | 2015-09-09 |
| 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 |
| 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.