IKDO STATE STREET LLC


Address: 9209 W State St, Garden City, ID 83714
Phone: 2083881111

IKDO STATE STREET LLC (NPI# 1932683752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1932683752
Entity Type Organization
Organization Name IKDO STATE STREET LLC
Practice Address 9209 W State St
Garden City
ID 83714
Practice Telephone 2083881111
Mailing Telephone 2083881111
Enumeration Date 2018-09-18
Last Update Date 2018-09-18
Authorized Official Name JAYCIE BIRCH (OFFICE MANAGER)
Authorized Official Telephone 2083881111
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 1223P0221X Dentist
Specialization: Pediatric Dentistry
Dental Providers
Y 1223X0400X Dentist
Specialization: Orthodontics and Dentofacial Orthopedics
Dental Providers

Office Location

Street Address 9209 W STATE ST
City GARDEN CITY
State ID
Zip Code 83714

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1437608007 Carrie Boroughs Breaux Ophthalmology 5019 N Sawyer Ave, Garden City, ID 83714 2016-09-23
1841646007 Alliance Medical Group, LLC Family Medicine 5601 W. Chinden Blvd., Garden City, ID 83714 2016-05-06
1134580467 Rebecca Gillet Physical Therapist 6576 W Dufferin Ct, Boise, ID 83714 2016-03-15
1063816007 Ingri Suzanne Koloski Counselor 8969 West Hepburn Lane, Garden City, ID 83714 2014-10-20
1679909329 Anile Nina Counselor 5484 N Gary Lane, Boise, ID 83714 2013-09-25
1215360292 William Blake Bybee Dentist 5833 W. Hidden Springs Dr., Boise, ID 83714 2013-08-14
1871833327 Charmaine Read Social Worker 123 E. 44th St, Ste. A, Garden City, ID 83714 2013-02-20
1811206576 Bennett Medical Services Durable Medical Equipment & Medical Supplies 5220 Sawyer Court, Suite D, Garden City, ID 83714 2010-09-29
1073780680 Barry Lynn Williams Pharmacist 7020 W State Street, Boise, ID 83714 2008-05-13
1417134107 Brenda Martin Speech-Language Pathologist 10387 W. Shadow Rock Drive, Boise, ID 83714 2008-01-25
Find all providers in zip 83714

Taxonomy Information

Taxonomy Code 1223X0400X
Grouping Dental Providers
Classification Dentist
Specialization Orthodontics and Dentofacial Orthopedics

Taxonomy Definition

That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1487883294 Susan Gail Tierney Dentist 154 Nassau Blvd, Garden City, NY 11530 2009-07-14
1437272556 Paul Alan Kinso Doi Dentist 1620 E Kansas Ave Ste A, Garden City, KS 67846-6293 2007-04-06
1225101207 John Francis Smollon Dentist 41 New Hyde Park Rd, Garden City, NY 11530-3947 2006-11-16
1356432454 Denise L Emma Dentist 70 7th St, Garden City, NY 11530-2800 2006-09-27
1083723662 Timothy A. Hanigan Dentist 1620 E Kansas Ave, Garden City, KS 67846-6233 2006-08-29
1598151250 Go Smile Orthodontics Dentist 520 Franklin Ave, L-19, Garden City, NY 11530-5806 2015-04-09
1992046023 Daniel Wallace Bythewood Dentist 520 Franklin Ave, Suite L-19, Garden City, NY 11530-5806 2013-03-14
1891947594 Darrell George Smith Dentist 325 West Logan Highway, Garden City, UT 84028 2008-10-14
1881884906 Arthur Mark Kammerman Dentist 226 7th St, Ste. 301, Garden City, NY 11530-5723 2007-07-25
1114058666 Garden City Orthodontics Dentist 70 7th St, Garden City, NY 11530-2800 2007-03-08
Find all providers in GARDEN CITY

Competitor

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City GARDEN CITY
Zip Code 83714

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Dataset Information

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.

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