Healthcare Provider Details

I. General information

NPI: 1316866825
Provider Name (Legal Business Name): JPDMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 N SUMMIT WAY SUITE 100
MERIDIAN ID
83646
US

IV. Provider business mailing address

4795 N SUMMIT WAY STE 120
MERIDIAN ID
83646-6697
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-0662
  • Fax: 208-888-0863
Mailing address:
  • Phone: 208-888-0662
  • Fax: 208-888-0863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JORDAN KENT PILLING
Title or Position: OWNER
Credential: DMD
Phone: 208-670-4276