# IDAHO DENTAL PROFESSIONALS, P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IDAHO DENTAL PROFESSIONALS, P.C.
- **Other names:** South Corner Dental Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1982442448
- **Legal business name:** IDAHO DENTAL PROFESSIONALS, P.C.
- **Authorized official:** CEMYIRA MCDOUGAL (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 764-8609

## Contact information

- **Practice address:** 4701 S EAGLE RD. STE. 100, MERIDIAN, ID 83642-7563
- **Practice address phone:** (208) 900-3350
- **Practice address fax:** (208) 900-3425
- **Mailing address:** 4701 S EAGLE RD. STE. 100, MERIDIAN, ID 83642-7563
- **Mailing address phone:** (208) 900-3350
- **Mailing address fax:** (208) 900-3425

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/18/2024
- **Last updated:** 07/18/2024