Healthcare Provider Details

I. General information

NPI: 1669661427
Provider Name (Legal Business Name): NS DOWNTOWN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 2ND ST S
NAMPA ID
83651-3837
US

IV. Provider business mailing address

607 2ND ST S
NAMPA ID
83651-3837
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-2456
  • Fax: 208-318-0227
Mailing address:
  • Phone: 208-466-2456
  • Fax: 208-466-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD3065
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KIM KELLER
Title or Position: OWNER
Credential: DDS
Phone: 208-466-2456