LAKE CITY DENTAL SPECIALTIES, PC (NPI# 1356693915) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356693915 |
| Entity Type | Organization |
| Organization Name | LAKE CITY DENTAL SPECIALTIES, PC |
| Practice Address |
1322 W Kathleen Ave Ste 2 Coeur D Alene ID 83815-7365 |
| Practice Telephone | 2086647300 |
| Practice Fax Number | 2086647333 |
| Mailing Telephone | 2086647300 |
| Mailing Fax Number | 2086647333 |
| Enumeration Date | 2012-10-07 |
| Last Update Date | 2012-10-07 |
| Authorized Official Name | DR. SHAUN MICHAEL WHITNEY (PRESIDENT) |
| Authorized Official Telephone | 2086647300 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223E0200X |
Dentist Specialization: Endodontics |
D4420EN | ID | Dental Providers |
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
D4420PE | ID | Dental Providers |
| Street Address |
1322 W KATHLEEN AVE STE 2 |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83815-7365 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275848582 | Shaun Michael Whitney | Dentist | 1322 W Kathleen Ave Ste 2, Coeur D Alene, ID 83815-7365 | 2010-08-11 |
| 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 | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619195310 | Brent Unruh | Dentist | 1717 Lincoln Way, Suite 107, Coeur D Alene, ID 83814-2556 | 2007-04-20 |
| 1881746048 | Brent R. Unruh, Dmd, Pa | Dentist | 1717 Lincoln Way, Suite 107, Coeur D Alene, ID 83814-2556 | 2007-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972968998 | Treasure Valley Periodontics | Dentist | 813 N Stilson Rd Ste C, Boise, ID 83703-5119 | 2015-12-17 |
| 1689077026 | Florence and Lincks and Associates | Dentist | 140 E Boise Ave Ste A, Boise, ID 83706-4374 | 2014-09-30 |
| 1588827125 | Richard E. Ferguson D.d.s.,m.s. Pa | Dentist | 813 Stilson Rd Ste C, Boise, ID 83703-5119 | 2008-07-03 |
| 1225255748 | Jason M Peterson | Dentist | 1980 1st St, Idaho Falls, ID 83401-4342 | 2007-04-18 |
| 1245310036 | Kenneth G. Sherman II | Dentist | 1228 N Cole Rd, Boise, ID 83704-8646 | 2006-10-16 |
| 1497835599 | Joel Newton | Dentist | 2064 Washington Street North, Twin Falls, ID 83301 | 2006-10-16 |
| 1710096896 | Bradley J. Morlock, D.d.s.,p.c. | Dentist | 3323 4th St, Lewiston, ID 83501-4423 | 2006-08-30 |
| 1700994852 | Bradley Lynn Townsend | Dentist | 6019 N. Eagle Rd., Boise, ID 83713 | 2006-08-28 |
| 1235147281 | Michael John Florence | Dentist | 140 East Boise Avenue, Boise, ID 83706 | 2006-08-04 |
| 1346224458 | Jack H Lincks | Dentist | 140 E Boise Ave, Boise, ID 83706-4373 | 2005-12-01 |
| 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.