KENT J ALLEN/ SHANNON WIDMIER (NPI# 1770769325) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770769325 |
| Entity Type | Organization |
| Organization Name | KENT J ALLEN/ SHANNON WIDMIER |
| Other Organization Name | PHEASANT COVE DENTAL |
| Practice Address |
702 Center St W Kimberly ID 83341 |
| Mailing Address |
702 Center Street West Po Box B Kimberly ID 83341 |
| Practice Telephone | 2084236444 |
| Practice Fax Number | 2084236903 |
| Mailing Telephone | 2084236444 |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-01-14 |
| Authorized Official Name | DR. KENT J ALLEN (OWNER) |
| Authorized Official Telephone | 2084236444 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D1767 | CA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | SMILES | 9201818 | 01 |
| ID | 000876700 | 05 |
| Other Name | Type Code |
|---|---|
| PHEASANT COVE DENTAL | Doing Business As Name - Organization |
| Street Address |
702 CENTER ST W |
| City | KIMBERLY |
| State | ID |
| Zip Code | 83341 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730575671 | Danton Lafey Bradshaw | Dentist | 702 Center St W, Kimberly, ID 83341-1722 | 2015-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063047470 | Northstar In Home Support Services | Social Worker | 3323 East B 3600 North, Kimberly, ID 83341 | 2020-03-05 |
| 1851889182 | Ammon Benjamin Birk | Physical Therapist | 940 Ballard Way, Kimberly, ID 83341 | 2018-04-23 |
| 1689161572 | Medsource Mobility LLC | Durable Medical Equipment & Medical Supplies | 319 Highway 30, Unit 3, Kimberly, ID 83341 | 2018-04-17 |
| 1710072046 | Helping Hands Sanctuary of Idaho | Psychiatric Hospital | 500 Polk St E, Kimberly, ID 83341 | 2006-10-03 |
| 1407954191 | Kent J. Allen | Dentist | 702 Center Street West, Kimberly, ID 83341 | 2006-09-20 |
| 1841393212 | Troy Alan Williams | Dentist | 1431 North Fillmore St, Twin Falls, ID 83341 | 2006-09-07 |
| 1386269983 | Caroline M Riley | Speech-Language Pathologist | 113 Main Street, Kimberly, ID 83341 | 2020-06-10 |
| 1265512297 | Northwest Bec Corp | Assisted Living Facility | 500 Polk St E, Kimberly, ID 83341 | 2006-10-16 |
| 1396842779 | Shannon Widmier | Dentist | 702 Center Street West, Kimberly, ID 83341 | 2006-09-20 |
| 1760717672 | Albert Paul Middleton | Pharmacist | 210 Main Street South, Kimberly, ID 83341-0000 | 2009-10-09 |
| Find all providers in zip 83341 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700241890 | Infinity Dental Pllc | Dentist | 622 Center St W, Kimberly, ID 83341-1720 | 2015-12-16 |
| 1750430088 | Daniel Allen Larson | Dentist | 317 E Kimberly Ave, Kimberly, WI 54136-1406 | 2007-01-09 |
| 1407954191 | Kent J. Allen | Dentist | 702 Center Street West, Kimberly, ID 83341 | 2006-09-20 |
| 1548273808 | Edward Theodore Bekx | Dentist | 203 W Kimberly Ave, Kimberly, WI 54136 | 2006-08-15 |
| 1477583870 | Joseph C Ferraro | Dentist | 1037-b Truman St., Kimberly, WI 54136 | 2006-07-03 |
| 1922296466 | Timothy James Bouressa | Dentist | 500 W 3rd St, Pob 96, Kimberly, WI 54136-1305 | 2007-10-10 |
| 1215124862 | Callie Irene Romenesko | Dentist | 1020 Truman St, Unit A, Kimberly, WI 54136-2215 | 2007-09-27 |
| 1215066626 | James Patrick Meyer | Dentist | 1020 Truman St, Suite A, Kimberly, WI 54136-2211 | 2007-03-02 |
| 1396842779 | Shannon Widmier | Dentist | 702 Center Street West, Kimberly, ID 83341 | 2006-09-20 |
| 1790798056 | Kimberly Dental Associates LLP | Dentist | 203 W Kimberly Ave, Kimberly, WI 54136 | 2006-08-15 |
| Find all providers in KIMBERLY | ||||
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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.