Intermountain Dental Specialists

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D3642EN Issued in ID

Legal business name

INTERMOUNTAIN DENTAL SPECIALISTS

Practice address

12249 W McMillan Rd
Boise, ID 83713-0555

Phone

(208) 917-2855

NPI assigned

Sep 30, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jerry Michael Carbone, D.M.DNPI 1316050628

Title

Managing Member

Phone

(208) 917-2855

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Jerry Michael Carbone, D.M.D.

  • Endodontics
  • Boise, ID
  • NPI 1316050628
  NPD (past) Authorized official

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

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412035200000",
    "number": "1134522535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12249 W MCMILLAN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130555",
            "telephone_number": "208-917-2855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12249 W MCMILLAN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130555",
            "telephone_number": "208-917-2855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN DENTAL SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-30",
        "last_updated": "2014-09-30",
        "status": "A",
        "authorized_official_last_name": "CARBONE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "208-917-2855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D3642EN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intermountain Chiropractic
• Intermountain Diagnostics Inc.
• Intermountain Diagnostics, Inc.
• Intermountain Eye and Laser Centers PLLC
• Intermountain Eye and Laser Centers PLLC
• Intermountain Functional Medicine, PLLC

• Dental Clinic/Center in Boise, ID
• Providers in Boise, 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 Sep 30, 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.