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).
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 |
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 |
Street Address |
9209 W STATE ST |
City | GARDEN CITY |
State | ID |
Zip Code | 83714 |
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 Code | 1223X0400X |
Grouping | Dental Providers |
Classification | Dentist |
Specialization | Orthodontics and Dentofacial Orthopedics |
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. |
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 |
City | GARDEN CITY |
Zip Code | 83714 |
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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.