NPI age
9 years
Enumerated 2016-06-15
● Active Type 2 · Organization
Idaho Innovative Dentistry, Pllc
Idaho Innovative Dentistry, Pllc is 1 of 202 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Porter
Dentist/owner
Last NPPES update
2016-06-15
Source: monthly bulk 2026-05
How this organization compares
Across 202 active clinic/center providers in Idaho.
NPI age
9 years
≈ at median (8 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2016 → 2026
2016-06Enumerated in NPPES
2016
2026
Where they practice
Primary practice location
467 S Rivershore Ln
Eagle, ID 836164978
Mailing address
467 S. Rivershore Lane
Eagle, ID 83616
Authorized official
Shane Steven Porter, DMD
Dentist/owner
📞 2089381247
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Greg Davis, D.D.S Dentist NPI 1699960039
- Lauren Yun, DDS Dentist NPI 1639394554
Specialties
-
Clinic/Center PrimaryDefinition to come...
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Premier Dentistry of Eagle
Practice context
Multi-provider organization. 2 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.