Tdcjerome PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4052 Issued in ID

Legal business name

TDCJEROME PLLC

Practice address

119 Country LN
Jerome, ID 83338-6147

Phone

(208) 324-8861

Fax

(208) 324-8899

NPI assigned

Oct 7, 2014

Organization subpart

No

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

Authorized official

Name

Don S Wyatt

Title

Owner

Phone

(208) 324-8861

Specialties & licenses 1

Addresses

Other names 1

• Today's Dental Care Doing business as

Locations

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412640000000",
    "number": "1104229913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 COUNTRY LN",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833386147",
            "telephone_number": "208-324-8861",
            "fax_number": "208-324-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 COUNTRY LN",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833386147",
            "telephone_number": "208-324-8861",
            "fax_number": "208-324-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TDCJEROME PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "DON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-324-8861"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Today's Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Malorie Stoker
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• General Practice Dentistry in Jerome, ID
• Providers in Jerome, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.