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

Southridge Dental

Organization General Practice Dentistry · NPI 1003010877

Southridge Dental is a General Practice Dentistry in Nampa, Idaho. Licensed in Idaho. Registered with an NPI since 2007.

Licensed in
ID
In the registry since
2007

Practice location Address checks out

2811 12th Ave Rd
Nampa, ID 83686-8482
Phone: (208) 466-2458
Fax: (208) 465-6303
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence D3499 (ID)

Record details

NPI number1003010877
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Pratt — Dentist · (208) 466-2458
NPI enumeratedJune 13, 2007
Last updated in NPPESAugust 22, 2020
Mailing address2811 12th Ave Rd, Nampa, ID 83686-8482

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