BLUESKY DENTAL
NPI: 1073808333
· MOSCOW, ID 83843
· General Practice Dentistry
· NPI assigned 06/15/2011
$978.25
Total Medicaid Paid
Provider Details
| Authorized Official | HENRY, KEVIN (OWNER) |
| NPI Enumeration Date | 06/15/2011 |
Related Entities
Other providers sharing the same authorized official: HENRY, KEVIN
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
24 |
$978.25 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
12 |
12 |
$978.25 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$0.00 |