OrganizationActive
Idaho Innovative Dentistry, PLLC
NPI 1649620139 · Dental Clinic/Center · Eagle, ID
Idaho Innovative Dentistry, PLLC is a Dental Clinic/Center organization in Eagle, ID (NPI 1649620139).
Provider details
- NPI number
- 1649620139
- Entity type
- Organization
- Primary specialty
- Dental Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Shane Porter, Dentist/Owner(208) 938-1247
- License
- D-4002 (ID)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(72/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
467 S Rivershore Ln
Eagle, ID 83616-4978
Phone: (208) 938-1247
Street-level locationGet directions
Mailing address
467 S. Rivershore Lane
Eagle, ID 83616
Other names (DBA / former)
- Doing business as
- Premier Dentistry of Eagle
Registry dates
- Enumerated
- 2016-06-15
- Last updated
- 2016-06-15
Frequently asked questions
- What is Idaho Innovative Dentistry, PLLC's NPI number?
- Idaho Innovative Dentistry, PLLC's National Provider Identifier (NPI) is 1649620139, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Idaho Innovative Dentistry, PLLC?
- Idaho Innovative Dentistry, PLLC is classified in the NPPES registry as Dental Clinic/Center (Ambulatory Health Care Facilities).
- Where is Idaho Innovative Dentistry, PLLC located?
- Idaho Innovative Dentistry, PLLC's practice location on file with NPPES is 467 S Rivershore Ln, Eagle, ID 83616-4978.
- What is Idaho Innovative Dentistry, PLLC's phone number?
- The practice phone number listed in the NPPES registry for Idaho Innovative Dentistry, PLLC is (208) 938-1247.
- Who is the authorized official for Idaho Innovative Dentistry, PLLC?
- The authorized official listed on Idaho Innovative Dentistry, PLLC's NPPES record is Shane Porter, Dentist/Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Idaho Innovative Dentistry, PLLC's NPI active?
- Yes — Idaho Innovative Dentistry, PLLC's NPI (1649620139) is active in the NPPES registry as of the last update on 2016-06-15.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.