BLAIR PEDIATRIC DENTISTRY PC (NPI# 1629483987) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629483987 |
| Entity Type | Organization |
| Organization Name | BLAIR PEDIATRIC DENTISTRY PC |
| Practice Address |
5360 N Eagle Rd Suite 103 Boise ID 83713-4901 |
| Practice Telephone | 2089389958 |
| Mailing Telephone | 2089389958 |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2014-06-25 |
| Authorized Official Name | DR. RANDALL P BLAIR (PRESIDENT) |
| Authorized Official Telephone | 7024859804 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
D4550PD | ID | Dental Providers |
| Street Address |
5360 N EAGLE RD SUITE 103 |
| City | BOISE |
| State | ID |
| Zip Code | 83713-4901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780778837 | Cynthia Ann Bridges | Dentist | 5360 N Eagle Rd, Suite 101, Boise, ID 83713-0963 | 2006-10-03 |
| 1871877704 | Veronica Montgomery | Dentist | 5360 N Eagle Rd, Suite # 101, Boise, ID 83713-4901 | 2011-10-11 |
| 1609946078 | Ryan W Judd | Dentist | 5360 N Eagle Rd, Boise, ID 83713-4901 | 2006-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| 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 |
|---|---|---|---|---|
| 1679665822 | Dentistry for Children | Dentist | 305 E Jefferson, Suite 103, Boise, ID 83712 | 2006-09-28 |
| 1235170044 | Roy H Rogers | Dentist | 1564 S Timesquare Ln, Boise, ID 83709-8266 | 2006-06-10 |
| 1962456632 | Scott Freeman | Dentist | 6363 Emerald, Boise, ID 83904 | 2006-05-19 |
| 1427012046 | Rodman Owen Emory | Dentist | 13014 W Persimmon Ln, Boise, ID 83713-1986 | 2006-04-12 |
| 1346771904 | Alexis Rachel Phillips | Dentist | 136 E Mallard Dr, Boise, ID 83706-3975 | 2017-03-24 |
| 1568902286 | Treasure Valley Pediatric Dentistry | Dentist | 1564 S Timesquare Ln, Boise, ID 83709-8266 | 2017-02-28 |
| 1801059209 | Cheryl Higer | Dentist | 305 E Jefferson St, Boise, ID 83712-6273 | 2008-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124657010 | Rigby Pediatric Dental Pllc | Dentist | 688 Rigby Lake Circle, Suite 4, Rigby, ID 83442 | 2020-04-03 |
| 1154805786 | Jmj Nampa LLC | Dentist | 914 12th Ave Rd, Nampa, ID 83686 | 2018-09-19 |
| 1932683752 | Ikdo State Street LLC | Dentist | 9209 W State St, Garden City, ID 83714 | 2018-09-18 |
| 1902325749 | Cherry Lane Kids Dentistry | Dentist | 1558 N Crestmont Dr Ste A, Meridian, ID 83642-2194 | 2017-09-13 |
| 1922462142 | Our Town Family Dentistry | Dentist | 39 W Idaho St, Weiser, ID 83672-1943 | 2016-04-13 |
| 1720447097 | Brock Coletti | Dentist | 3235 N Towerbridge Way Ste 200, Meridian, ID 83646-5721 | 2016-02-15 |
| 1154799047 | Smiles 4 Kids Blackfoot Pllc | Dentist | 621 Jensen Grove Dr, Blackfoot, ID 83221-1685 | 2015-09-09 |
| 1982012498 | Dallin J. Dance | Dentist | 1027 W. Prairie Ave., Hayden, ID 83835 | 2014-07-28 |
| 1679812002 | Dentistry for Kids Pllc | Dentist | 625 E Alameda Rd., Pocatello, ID 83201 | 2013-02-05 |
| 1609106012 | Cordell Denton Nebeker | Dentist | 4111 Clocktower Ave., Caldwell, ID 83607 | 2010-01-07 |
| 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.