NPI age
1 years
Enumerated 2024-05-29
● Active Type 2 · Organization
Subpart
Id Sds II Pllc
Id Sds II Pllc is 1 of 135 dentist organizations in Idaho.
Primary specialty
Dentist
Practice locations
2
1 secondary on file
Status
Active
No deactivations on record
Authorized official
Dasch
Director Of Credentialing
Last NPPES update
2025-03-03
Source: monthly bulk 2026-05
How this organization compares
Across 135 active dentist providers in Idaho.
NPI age
1 years
↓ 17 yr below median
Practice locations
2
1 secondary on file
Subspecialties
0
NPI lifetime · 2024 → 2026
2024-05Enumerated in NPPES
2024
2026
Where they practice
Primary practice location
1541 S Timesquare Ln
Boise, ID 837098266
Mailing address
1610 54th Ave N Ste 205
Nashville, TN 372091442
Additional practice locations
1 secondary location on file with NPPES.
Location 2
450 E State St Ste 100
Eagle, ID 836165030
Authorized official
Charlotte V Dasch
Director Of Credentialing
📞 5046380303
Specialties
-
Dentist PrimaryThat area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and...
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Super Smiles Orthodontics
-
Super Smiles Orthodontics
Practice context
Multi-site organization. 1 additional practice location on file.
Subpart of Id Specialty Dental Services, Pllc.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.