BLUE CREEK ENDODONTICS (NPI# 1417353830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417353830 |
| Entity Type | Organization |
| Organization Name | BLUE CREEK ENDODONTICS |
| Practice Address |
3240 E Louise Dr Suite 110 Meridian ID 83642-5107 |
| Practice Telephone | 2085784700 |
| Practice Fax Number | 2085784704 |
| Mailing Telephone | 2085784700 |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2014-11-12 |
| Authorized Official Name | JAMES ANTHONY EATON (PRESIDENT) |
| Authorized Official Telephone | 9012672294 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
D-4611-EN | ID | Dental Providers |
| Street Address |
3240 E LOUISE DR SUITE 110 |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-5107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 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 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831435460 | James Anthony Eaton | Dentist | 3240 E Louise Dr # 110, Meridian, ID 83642-5107 | 2013-01-01 |
| 1912113036 | Matthew R Buhrley | Dentist | 742 W Cherry Ln, Meridian, ID 83642-1617 | 2007-05-15 |
| 1699981183 | Mark Wayne Moore | Dentist | 2301 12th St, Meridian, MS 39301-3934 | 2007-05-14 |
| 1316040975 | Louis J Buhrley | Dentist | 1552 North Crestmont Dr, Ste # B, Meridian, ID 83642 | 2006-09-07 |
| 1538500657 | Daniel Brent Jenks | Dentist | 1075 S Wells St, Meridian, ID 83642-7997 | 2013-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1174888473 | Dean Philip Whiting | Dentist | 602 North Calgary Court, 301, Post Falls, ID 83854 | 2012-07-12 |
| 1437455961 | Herbert Ray Blaser | Dentist | 2104 N. Cole Rd., Boise, ID 83704 | 2011-02-01 |
| 1295035020 | Dustin Lee Gatten | Dentist | 602 N Calgary Ct Ste 301, Post Falls, ID 83854-4000 | 2010-10-27 |
| 1275848582 | Shaun Michael Whitney | Dentist | 1322 W Kathleen Ave Ste 2, Coeur D Alene, ID 83815-7365 | 2010-08-11 |
| 1497918809 | Stanton D Widmer | Dentist | 4207 Clocktower Ave., Caldwell, ID 83607-5236 | 2008-07-07 |
| 1659590693 | Bart Baty Morrison | Dentist | 3335 S Holmes Ave, Idaho Falls, ID 83404-7981 | 2007-04-25 |
| 1396961157 | Larue Antoine Bluth | Dentist | 5244 N Eagle Rd, Boise, ID 83713-0945 | 2007-04-18 |
| 1255458154 | Timothy Lee Gatten | Dentist | 602 N. Calgary Ct., Suite 301, Post Falls, ID 83854 | 2007-03-23 |
| 1417096678 | Idaho Endodontics Pa | Dentist | 2014 N Cole Rd, Boise, ID 83704 | 2007-02-05 |
| Find all providers with the same taxonomy | ||||
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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.