TREASURE VALLEY PERIODONTICS (NPI# 1972968998) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972968998 |
| Entity Type | Organization |
| Organization Name | TREASURE VALLEY PERIODONTICS |
| Practice Address |
813 N Stilson Rd Ste C Boise ID 83703-5119 |
| Practice Telephone | 2083440908 |
| Mailing Telephone | 2083440908 |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2015-12-17 |
| Authorized Official Name | DR. KATHLEEN A BEAUDRY (OWNER) |
| Authorized Official Telephone | 2083440908 |
| Authorized Official Credential | D.M.D., M.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
D-4444-PE | ID | Dental Providers |
| Street Address |
813 N STILSON RD STE C |
| City | BOISE |
| State | ID |
| Zip Code | 83703-5119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386203974 | Dylan Roy | Chiropractor | 5632 W State Street, Boise, ID 83703 | 2019-06-07 |
| 1124476858 | Tidwell Social Work Services and Consulting, Inc. | Community/Behavioral Health | 5999 W. State St., Boise, ID 83703 | 2016-06-03 |
| 1801251244 | Rebecca Lynn Cushing | Massage Therapist | 5909 W. State St, Boise, ID 83703 | 2015-12-30 |
| 1790181675 | Malinda Poe | Counselor | 4440 W Taft St, Boise, ID 83703 | 2014-11-05 |
| 1689079469 | Ashley Harker | Massage Therapist | 5909 W. State St., Boise, ID 83703 | 2014-10-23 |
| 1770987844 | Brick House Recovery | Counselor | 3663 N Lakeharbor Ln, Boise, ID 83703 | 2014-10-17 |
| 1033512538 | Ryan Warburton | Physical Therapist | 2999 N Lakeshore Lane, Ste 120, Boise, ID 83703 | 2014-09-29 |
| 1710386008 | Suzanne Iannaccone | Social Worker | 4090 W State St Ste 221, Boise, ID 83703 | 2014-08-22 |
| 1588092464 | Becky L. Marks | Social Worker | 3858 N. Garden Center Way, Suite 204, Boise, ID 83703 | 2013-10-31 |
| 1700219169 | Pohley Richey | Dietitian, Registered | 6052 W State Street, Boise, ID 83703 | 2013-08-20 |
| Find all providers in zip 83703 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 1245310036 | Kenneth G. Sherman II | Dentist | 1228 N Cole Rd, Boise, ID 83704-8646 | 2006-10-16 |
| 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 |
| 1194175232 | Idaho Perio Center for Dental Implants & Laser Periodontal Therapy | Dentist | 6019 N Eagle Rd, Boise, ID 83713-0997 | 2016-06-20 |
| 1447481726 | Stephen Schenk, D.d.s., P.C. | Dentist | 1228 N Cole Rd, Boise, ID 83704-8646 | 2009-08-04 |
| 1871765974 | Stephen Frederick Schenk | Dentist | 1228 N Cole Rd, Boise, ID 83704-8646 | 2008-03-28 |
| 1710050943 | Richard E Ferguson | Dentist | 813 Stilson Rd, Suite C, Boise, ID 83703-5119 | 2006-11-16 |
| Find all providers in BOISE | ||||
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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.