NPI age
9 years
Enumerated 2016-05-31
● Active Type 2 · Organization
Avalon Dental Pc
Avalon Dental Pc 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
Grant
Owner
Last NPPES update
2016-05-31
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
2016-05Enumerated in NPPES
2016
2026
Where they practice
Primary practice location
672 E Wythe Creek Ct, Ste 101
Kuna, ID 836345216
Mailing address
672 E Wythe Creek Ct, Ste 101
Kuna, ID 836345216
Authorized official
James D. Grant, DMD
Owner
📞 2086292800
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Alexis Pettersen, PT, DPT Physical Therapist NPI 1386474500
- Mikaela Virgin, PT Physical Therapist NPI 1871210500
Specialties
-
Clinic/Center PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1447345491 | INDIVIDUAL PROVIDER |
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 →
- 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.