Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Idaho Innovative Dentistry, PLLC

Organization Dental Clinic/Center · NPI 1649620139

Idaho Innovative Dentistry, PLLC is a Dental Clinic/Center in Eagle, Idaho. Licensed in Idaho. Registered with an NPI since 2016.

Licensed in
ID
In the registry since
2016
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

467 S Rivershore Ln
Eagle, ID 83616-4978
Phone: (208) 938-1247
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X · Licence D-4002 (ID)

Record details

NPI number1649620139
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shane Porter — Dentist/Owner · (208) 938-1247
Other names Premier Dentistry Of Eagle
NPI enumeratedJune 15, 2016
Last updated in NPPESJune 15, 2016
Mailing address467 S. Rivershore Lane, Eagle, ID 83616

Other providers in Eagle