Russell C. Pool, DMD, PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D1687 Issued in ID

Legal business name

RUSSELL C. POOL, DMD, PA

Practice address

109 12TH Ave Rd
Nampa, ID 83686-5047

Phone

(208) 467-2545

Fax

(208) 466-3607

NPI assigned

Jun 25, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Russell C. Pool, DMD

Title

President

Phone

(208) 467-2545

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kirk L. Jenkins, D.D.S.

  • General Practice Dentistry
  • Nampa, ID
  • NPI 1972656130
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1093977647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836865047",
            "telephone_number": "208-467-2545",
            "fax_number": "208-466-3607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836865047",
            "telephone_number": "208-467-2545",
            "fax_number": "208-466-3607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL C. POOL, DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "POOL",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-467-2545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D1687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "66852",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randall L Rudeen, MD
• Jennifer Ruhter
• Laura Giselle Ruiz-Bernal
• Donald Shelby Rupe, OT
• Abbey Michelle Rushton
• Emily Grace Bond Russell, PA-C
• Hadley Brynn Russell
• Megan Russell
• Melinda Russell, LCSW
• Melissa Ann Brightstar Ruth, MS, LPC

• Dental Clinic/Center in Nampa, ID
• Providers in Nampa, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.