E.T. Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

E.T. DENTAL LLC

Doing business as

Complete Dental Care of North Idaho

Practice address

418 W Cameron Ave
Kellogg, ID 83837-2111

Phone

(208) 682-4540

NPI assigned

Sep 8, 2020

Last updated

Sep 8, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Aaron Dollahite

Title

Ceo

Phone

(208) 699-0022

Specialties & licenses 1

Addresses

Other names 1

• Complete Dental Care of North Idaho Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jayson Anders Bird, DDS

  • Dentist
  • Pinehurst, ID
  • NPI 1629416151
  NPD (past)

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1154935039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 W CAMERON AVE",
            "city": "KELLOGG",
            "state": "ID",
            "postal_code": "838372111",
            "telephone_number": "208-682-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 W CAMERON AVE",
            "city": "KELLOGG",
            "state": "ID",
            "postal_code": "838372111",
            "telephone_number": "208-682-4540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E.T. DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "DOLLAHITE",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-699-0022"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complete Dental Care of North Idaho",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dakota Baker DDS PLLS
• Lisa Joann Darst, MPT
• Daybreak Canyon LLC
• Tricia Lynn Dickens, MD
• Dirne Health Centers, Inc (Heritage Health Kellogg)
• Evergreen Wellness, LLC
• Rachel Ewing, RDN, LD
• Robert Forsyth Fallon Jr., MD
• Filip E Orban DDS PA
• Foot and Ankle Clinic of Spokane Inc

• General Practice Dentistry in Kellogg, ID
• Providers in Kellogg, 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 Sep 8, 2020; 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.