NPIMap

Organization Active NPI

Foothills Dental Care, PLLC

  • Dentist
  • Idaho Falls, ID
National Provider Identifier
1205175668
Registry record updated Feb 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D3971 Issued in ID
Legal business name
FOOTHILLS DENTAL CARE, PLLC
Practice address
1655 Pancheri Dr
Idaho Falls, ID 83402-3169
Phone
(208) 522-1911
Fax
(208) 523-4441
NPI assigned
Feb 5, 2013
Organization subpart
Yes
Parent organization
FOOTHILLS DENTAL CARE, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2013

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

Authorized official

Name
Mrs. Melissa K Raichart
Title
Insurance Coordinator
Phone
(208) 529-4484

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D3971 ID Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D3464 ID
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D4302 ID
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D1719 ID

Addresses

Primary practice location

1655 Pancheri Dr
Idaho Falls, ID 83402-3169

Mailing address

2205 Channing Way
Suite a
Idaho Falls, ID 83404-8016
Phone (208) 529-4484

Other identifiers 6

IdentifierTypeStateIssuer
1124035498MedicaidID
1740501410MedicaidID
1134356140MedicaidID
1952317703MedicaidID
1275619090MedicaidID
1609952415MedicaidID

Other names 1

  • RiverWest Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Foothills Dental Care2 organizations share this tax ID, including this one
Part of
Foothills Dental Care

Other organizations with this tax ID 1

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

Locations

2205 Channing Way
Ste A
Idaho Falls, ID 83404
Phone (208) 529-4484

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360108800000",
    "number": "1205175668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 CHANNING WAY",
            "address_2": "SUITE A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048016",
            "telephone_number": "208-529-4484",
            "fax_number": "208-523-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 PANCHERI DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023169",
            "telephone_number": "208-522-1911",
            "fax_number": "208-523-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS DENTAL CARE, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOOTHILLS DENTAL CARE, PLLC",
        "enumeration_date": "2013-02-05",
        "last_updated": "2013-02-06",
        "status": "A",
        "authorized_official_last_name": "RAICHART",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "208-529-4484",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3971",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3464",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D4302",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D1719",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124035498",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740501410",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134356140",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952317703",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275619090",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609952415",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RiverWest Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; 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.