KOOTENAI DENTAL GROUP, LLC (NPI# 1265532261) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265532261 |
| Entity Type | Organization |
| Organization Name | KOOTENAI DENTAL GROUP, LLC |
| Other Organization Name | DELWYN LEE DICK, D.D.S. |
| Practice Address |
555 W. Canfield Avenue Coeur D'alene ID 83815-7892 |
| Practice Telephone | 2087628750 |
| Practice Fax Number | 2087622530 |
| Mailing Telephone | 2087628750 |
| Mailing Fax Number | 2087622530 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. DELWYN LEE DICK (CEO) |
| Authorized Official Telephone | 2087628750 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
ID03049 | ID | Dental Providers |
| Other Name | Type Code |
|---|---|
| DeLwyn Lee Dick, D.D.S. | Other Name - Individual/Organization |
| Street Address |
555 W. CANFIELD AVENUE |
| City | COEUR D'ALENE |
| State | ID |
| Zip Code | 83815-7892 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790133163 | Christine Lee Stanton | Speech-Language Pathologist | 3825 N. Blalock Drive, Coeur D'alene, ID 83815 | 2016-05-26 |
| 1578921961 | Kayla Wearne | Speech-Language Pathologist | 917 W Canfield Avenue, Coeur D'alene, ID 83815 | 2016-02-01 |
| 1770954794 | William Strong | Speech-Language Pathologist | 3902 Broken Arrow Rd, Coeur D Alene, ID 83815 | 2015-10-16 |
| 1235517079 | Denny Bordeaux | Emergency Medical Technician, Paramedic | 7294 Downing Lane, Coeur D Alene, ID 83815 | 2015-05-13 |
| 1689075657 | Barbara Campbell | Pharmacist | W 201 Neider Rd., Coeur D'alene, ID 83815 | 2014-09-10 |
| 1710313671 | Sean Cooper | Pharmacist | W. 201 Neider Rd., Coeur D' Alene, ID 83815 | 2013-09-23 |
| 1275871329 | Lake City Dental | Dentist | 6176 Government Way, Coeur D'alene, ID 83815 | 2013-01-24 |
| 1881972701 | A Better Personal Care Inc | In Home Supportive Care | 3115 N Government Way Ste 2, Coeur D'alene, ID 83815 | 2011-07-26 |
| 1013206895 | Robert Sperry | Pharmacist | 41650 W Maricopacg Hwy., Maricopa, AZ 83815 | 2011-04-01 |
| 1629304670 | Marciea W. Buckley | Social Worker | 109 Harrison Ave, Coeur D' Alene, ID 83815 | 2009-10-27 |
| Find all providers in zip 83815 | ||||
| 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 |
|---|---|---|---|---|
| 1275871329 | Lake City Dental | Dentist | 6176 Government Way, Coeur D'alene, ID 83815 | 2013-01-24 |
| 1326393786 | Laser Dentistry of Coeur D'alene | Dentist | 910 W. Ironwood Dr., Coeur D'alene, ID 83814 | 2012-07-20 |
| 1205120441 | Donald J Johnson Dds Inc | Dentist | 114 W Neider Ave, Coeur D'alene, ID 83815-9300 | 2011-06-06 |
| 1629153150 | Donald J Johnson | Dentist | 114 W. Neider Ave., Coeur D'alene, ID 83815 | 2006-10-25 |
| 1841396082 | Kent E Mosby | Dentist | 910 W Ironwood Dr, Coeur D'alene, ID 83814 | 2006-09-15 |
| 1548600265 | Gary Bills | Dentist | 700 Ironwood Dr, Ste 218, Coeur D'alene, ID 83814 | 2013-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891304556 | Birchwood Dental, Pllc | Dentist | 3325 N Ten Mile Rd Ste 140, Meridian, ID 83646-6951 | 2020-07-29 |
| 1588273635 | Atlantis Dental Care, P.a. | Dentist | 13238 W Persimmon Ln Ste 100, Boise, ID 83713-1968 | 2020-07-24 |
| 1235747338 | Dentists of Boise and Orthodontics, PC | Dentist | 7500 W State St Ste 110, Boise, ID 83714-6074 | 2020-07-15 |
| 1346895232 | Tejasi Avasare | Dentist | 8321 W Overland Rd, Boise, ID 83709-1640 | 2019-08-07 |
| 1740835248 | Braden Comstock | Dentist | 2329 N Merritt Creek Loop, Coeur D Alene, ID 83814-4950 | 2019-08-02 |
| 1902450430 | Jaren M Thueson | Dentist | 106 E 1st N, Rexburg, ID 83440-1614 | 2019-08-01 |
| 1528610359 | Melissa Marie Pysnak | Dentist | 8850 W Emerald St Ste 150, Boise, ID 83704-4809 | 2019-07-11 |
| 1811555758 | Daniel Whitesitt | Dentist | 14596 Id-41, Rathdrum, ID 83858 | 2019-06-05 |
| 1104483122 | Meghan Cyrena Bristlin | Dentist | 3326 4th St Ste 3, Lewiston, ID 83501-4455 | 2019-05-24 |
| 1124684584 | Trevor Tafoya Dds Victory Dental, Pllc | Dentist | 7421 W Victory Rd, Boise, ID 83709-5106 | 2019-05-11 |
| Find all providers with the same taxonomy | ||||
| City | COEUR D'ALENE |
| Zip Code | 83815 |
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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.