ALLIGATOR PEDIATRIC DENTISTRY ,PLLC — NPI 1679747588 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in AMMON, ID)

CMS-1500 Box 24J / 33a • NPI

1679747588

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1223P0221X

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

2805 EAGLE DRIVE, AMMON, ID, 83406

Official NPPES Practice Location

Practice Phone & Referral Fax

(208) 542-1333

Fax: (208) 552-7296

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1679747588 (ALLIGATOR PEDIATRIC DENTISTRY ,PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1679747588` (NPI-2 Organization / Facility)
Provider / Legal Name	ALLIGATOR PEDIATRIC DENTISTRY ,PLLC
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223P0221X` (Dentist, Pediatric Dentistry)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	2805 EAGLE DRIVE, AMMON, ID, 83406
Practice Telephone / Fax	Tel: (208) 542-1333 \| Fax: (208) 552-7296
Administrative Mailing Address	2805 EAGLE DRIVE, AMMON, ID, 83406
Enumeration & Last Sync	Enumerated: 2008-04-22 \| CMS Record Updated: 2024-04-08
Authorized Official	RANDY SMITH (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2805 EAGLE DRIVE, AMMON, ID, 83406

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Plain-English Taxonomy & CMS Crosswalk (1223P0221X)

What Does Taxonomy Code 1223P0221X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223P0221X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ALLIGATOR PEDIATRIC DENTISTRY ,PLLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223P0221X` — Dentist, Pediatric Dentistry Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: ID \| License: `D3257PD` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ALLIGATOR PEDIATRIC DENTISTRY ,PLLC (NPI #1679747588)