LAKE HARBOR DENTAL PLLC (NPI# 1427669720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427669720 |
| Entity Type | Organization |
| Organization Name | LAKE HARBOR DENTAL PLLC |
| Practice Address |
5355 W State St Boise ID 83703-3333 |
| Practice Telephone | 2088534687 |
| Mailing Telephone | 2088534687 |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-08-11 |
| Authorized Official Name | ERIC BALLOU (OWNER) |
| Authorized Official Telephone | 2088534687 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
5355 W STATE ST |
| City | BOISE |
| State | ID |
| Zip Code | 83703-3333 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942472691 | Michael E Peterson | Dentist | 5355 W State St, Boise, ID 83703-3333 | 2008-04-01 |
| 1639310089 | Lake Harbor Dental | Dentist | 5355 W State St, Boise, ID 83703-3333 | 2009-03-16 |
| 1952561003 | Eric Ballou | Dentist | 5355 W State St, Boise, ID 83703-3333 | 2008-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386203974 | Dylan Roy | Chiropractor | 5632 W State Street, Boise, ID 83703 | 2019-06-07 |
| 1124476858 | Tidwell Social Work Services and Consulting, Inc. | Community/Behavioral Health | 5999 W. State St., Boise, ID 83703 | 2016-06-03 |
| 1801251244 | Rebecca Lynn Cushing | Massage Therapist | 5909 W. State St, Boise, ID 83703 | 2015-12-30 |
| 1790181675 | Malinda Poe | Counselor | 4440 W Taft St, Boise, ID 83703 | 2014-11-05 |
| 1689079469 | Ashley Harker | Massage Therapist | 5909 W. State St., Boise, ID 83703 | 2014-10-23 |
| 1770987844 | Brick House Recovery | Counselor | 3663 N Lakeharbor Ln, Boise, ID 83703 | 2014-10-17 |
| 1033512538 | Ryan Warburton | Physical Therapist | 2999 N Lakeshore Lane, Ste 120, Boise, ID 83703 | 2014-09-29 |
| 1710386008 | Suzanne Iannaccone | Social Worker | 4090 W State St Ste 221, Boise, ID 83703 | 2014-08-22 |
| 1588092464 | Becky L. Marks | Social Worker | 3858 N. Garden Center Way, Suite 204, Boise, ID 83703 | 2013-10-31 |
| 1700219169 | Pohley Richey | Dietitian, Registered | 6052 W State Street, Boise, ID 83703 | 2013-08-20 |
| Find all providers in zip 83703 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831678903 | Town Square Dental Partners, Pllc | Clinic/Center | 8660 W Emerald St Ste 152, Boise, ID 83704-4828 | 2018-08-09 |
| 1265935902 | Wilson Dental Pllc | Clinic/Center | 10497 W Garverdale Ct Ste 107, Boise, ID 83704-5468 | 2018-03-08 |
| 1912356841 | Joseph P. Schmidt Pllc | Clinic/Center | 2600 W Rose Hill St, Suite 100, Boise, ID 83705-5967 | 2016-06-10 |
| 1487046363 | Boise Caring Dentistry, P.C. | Clinic/Center | 5630 N Eagle Rd, Suite 101, Boise, ID 83713-4901 | 2015-03-02 |
| 1598154981 | Horizon 1 Pllc | Clinic/Center | 1000 N Curtis Rd Ste 103, Boise, ID 83706-1345 | 2015-01-22 |
| 1336220144 | Robert O Stevens Dmd, Pa | Clinic/Center | 10572 W Business Park Ln, Boise, ID 83709-6797 | 2006-10-18 |
| 1902810633 | Community Health Clinics | Clinic/Center | 2301 N 36th St, Suite 102, Boise, ID 83703-5207 | 2006-07-28 |
| 1255339297 | Dr. Kaci B. Jensen, Pllc | Clinic/Center | 9755 W Leo Dr, Boise, ID 83709-8249 | 2005-07-13 |
| 1659915437 | Weimer Dental Pllc | Clinic/Center | 8336 W Northview St, Boise, ID 83704-7132 | 2019-11-04 |
| 1497317788 | Hidden Springs Dental | Clinic/Center | 5833 W Hidden Springs Dr, Boise, ID 83714-9453 | 2019-07-08 |
| Find all providers in BOISE | ||||
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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.