Oliver Oneal Thuernagle, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3902 Issued in ID

Practice address

1685 Pancheri Dr
Idaho Falls, ID 83402-3169

Phone

(208) 523-0840

Fax

(208) 523-0921

NPI assigned

Jul 22, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Dental

  • General Practice Dentistry
  • Idaho Falls, ID
  • NPI 1841204609
  NPD (past) Authorized official

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215958376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4935 JUPITER HILLS DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834016344",
            "telephone_number": "208-528-7537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1685 PANCHERI DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023169",
            "telephone_number": "208-523-0840",
            "fax_number": "208-523-0921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THUERNAGLE",
        "first_name": "OLIVER",
        "middle_name": "ONEAL",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80724800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jared Kent Thornton, D.C.
• Jason M Thornton, CRNA
• Travis Thornton, LCSW
• Thrifty Payless Inc
• Throne of Grace, LLC.
• Shawn L Thurber, PHD
• Rachel Lauren Tice, LCPC
• Amanda Joy Tillo, LCPC
• Tim Thurman MD PC
• Jay M Tingey, M.D

• General Practice Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.