Healthcare Provider Details

I. General information

NPI: 1124183207
Provider Name (Legal Business Name): KORY BINGHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 RIGBY LAKE DR STE 4
RIGBY ID
83442-1285
US

IV. Provider business mailing address

688 RIGBY LAKE DR STE 4
RIGBY ID
83442-1285
US

V. Phone/Fax

Practice location:
  • Phone: 208-745-2010
  • Fax:
Mailing address:
  • Phone: 208-716-9724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1361
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE00009846
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD-3493-PD
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: