Idaho Innovative Dentistry, Pllc
Idaho Innovative Dentistry, Pllc is a healthcare organization registered as Dental Clinic/Center in Eagle, ID, holding Type 2 (organization) NPI 1649620139 since 2016. The authorized official on file is Shane Porter, Dentist/Owner.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1649620139 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Idaho Innovative Dentistry, Pllc |
| Other name | <Unavail> |
| Practice address | 467 S RIVERSHORE LN, Eagle, ID, 83616 |
| Phone | 2089381247 |
| Enumeration date | 2016-06-15 |
| Last updated in NPPES | 2016-06-15 |
Authorized official
| Name | Shane Porter |
|---|---|
| Title | Dentist/Owner |
| Phone | 2089381247 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 261QD0000X | Dental Clinic/Center | Primary | D-4002 | ID |
Copy-ready billing details
Provider: Idaho Innovative Dentistry, Pllc NPI: 1649620139 Taxonomy: 261QD0000X (Dental Clinic/Center) Address: 467 S RIVERSHORE LN, Eagle, ID, 83616
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1639394554 | Lauren Yun | Individual | General Practice Dentistry | Eagle, ID |
| 1699960039 | Greg Davis | Individual | Dentist | Eagle, ID |
Verify this record
Cross-check NPI 1649620139 against the authoritative CMS record: view Idaho Innovative Dentistry, Pllc on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What type of organization is Idaho Innovative Dentistry, Pllc?
What is a Type 2 NPI?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2016-06-15.