Healthcare Provider Details

I. General information

NPI: 1447864384
Provider Name (Legal Business Name): KUNA KIDS DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 N. MERIDIAN ROAD STE 150
KUNA ID
83634
US

IV. Provider business mailing address

7887 E BELLEVIEW AVE STE 250
ENGLEWOOD CO
80111-6011
US

V. Phone/Fax

Practice location:
  • Phone: 208-971-0396
  • Fax:
Mailing address:
  • Phone: 720-603-4788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADISON LEHMAN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 720-603-4779