IKDO SOUTH MERIDIAN LLC (NPI# 1174145684) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174145684 |
| Entity Type | Organization |
| Organization Name | IKDO SOUTH MERIDIAN LLC |
| Practice Address |
3839 E Amity Rd Meridian ID 83642 |
| Mailing Address |
3289 N Towerbridge Way Meridian ID 83646-8347 |
| Practice Telephone | 2089994999 |
| Mailing Telephone | 2088844466 |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2020-05-07 |
| Authorized Official Name | MICHAEL D PAYNE (OWNER) |
| Authorized Official Telephone | 2088844466 |
| 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 |
| Street Address |
3839 E AMITY RD |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| 1861982456 | St Lukes Clinic - Treasure Valley LLC | Preventive Medicine | 5155 S Howry Lane, Meridian, ID 83642 | 2018-05-18 |
| Find all providers in zip 83642 | ||||
| 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 |
|---|---|---|---|---|
| 1902325749 | Cherry Lane Kids Dentistry | Dentist | 1558 N Crestmont Dr Ste A, Meridian, ID 83642-2194 | 2017-09-13 |
| 1720447097 | Brock Coletti | Dentist | 3235 N Towerbridge Way Ste 200, Meridian, ID 83646-5721 | 2016-02-15 |
| 1811156722 | Meridian Pediatric Dentistry, Pllc | Dentist | 1550 E Heritage Park St Ste 150, Meridian, ID 83646-5886 | 2008-06-05 |
| 1659546174 | Randall Parley Blair | Dentist | 37 W Archerfield St Ste 100, Meridian, ID 83646-6587 | 2008-04-25 |
| 1710068739 | J Britt Mccarty | Dentist | 1922 23rd Ave, Meridian, MS 39301-3107 | 2006-10-17 |
| 1407801939 | Toby O Merriman | Dentist | 1550 E Heritage Park St, Ste 150, Meridian, ID 83646-5886 | 2006-05-23 |
| 1326098682 | Joel E Whitt | Dentist | 3235 N Towerbridge Way, Suite 200, Meridian, ID 83646 | 2006-05-10 |
| 1962466292 | Lawrence Wayne Meadors | Dentist | 2300 W Everest Ln, Suite 125, Meridian, ID 83646-5925 | 2006-04-13 |
| 1356606511 | Meridian Pediatric Dental Group, LLC | Dentist | 1922 23rd Ave, Meridian, MS 39301 | 2012-07-12 |
| 1972863678 | Dental Care for Kids | Dentist | 3235 N Towerbridge Way, Suite 200, Meridian, ID 83646-5721 | 2012-05-29 |
| Find all providers in MERIDIAN | ||||
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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.