NPIMap

Organization Active NPI

Two Rivers Dental, PLLC

  • General Practice Dentistry
  • Mackay, ID
National Provider Identifier
1174829238
Registry record updated Feb 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D4109 Issued in ID
Legal business name
TWO RIVERS DENTAL, PLLC
Practice address
304 S Main St
Mackay, ID 83251
Phone
(208) 588-3316
Fax
(208) 588-3166
NPI assigned
Feb 7, 2011
Last updated
Feb 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2011

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

Authorized official

Name
Jed C Snow, D.M.D.
Title
Dentist
Phone
(208) 588-3316

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D4109 ID Primary

Addresses

Primary practice location

304 S Main St
Mackay, ID 83251

Mailing address

PO Box 86
304 S Main St
Mackay, ID 83251
Phone (208) 588-3316

National Provider Directory

National Provider Directory
Tax ID family
Two Rivers Dental PLLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1297036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297036800000",
    "number": "1174829238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86",
            "address_2": "304 S MAIN ST",
            "city": "MACKAY",
            "state": "ID",
            "postal_code": "83251",
            "telephone_number": "208-588-3316",
            "fax_number": "208-588-3166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S MAIN ST",
            "city": "MACKAY",
            "state": "ID",
            "postal_code": "83251",
            "telephone_number": "208-588-3316",
            "fax_number": "208-588-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWO RIVERS DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-07",
        "last_updated": "2011-02-07",
        "status": "A",
        "authorized_official_last_name": "SNOW",
        "authorized_official_first_name": "JED",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-588-3316",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mackay, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; 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.