Active NPI
Michael G Dolby, DDS
- General Practice Dentistry
- Eagle, ID
National Provider Identifier
1235352055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D3114
- Practice address
- 90 Cottonwood CT Ste 100
Eagle, ID 83616-6577 - Phone
- (208) 323-8545
- Fax
- (208) 938-1401
- NPI assigned
- Apr 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D3114 | ID | Primary |
Addresses
Primary practice location
90 Cottonwood CT Ste 100
Eagle, ID 83616-6577
Mailing address
90 Cottonwood CT Ste 100
Eagle, ID 83616-6577
Phone (208) 323-8545
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D-3114 | Other | ID | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D3114 | ID | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1235352055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 COTTONWOOD CT STE 100",
"city": "EAGLE",
"state": "ID",
"postal_code": "836166577",
"telephone_number": "208-323-8545",
"fax_number": "208-938-1401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 COTTONWOOD CT STE 100",
"city": "EAGLE",
"state": "ID",
"postal_code": "836166577",
"telephone_number": "208-323-8545",
"fax_number": "208-938-1401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOLBY",
"first_name": "MICHAEL",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-10",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D3114",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "D-3114",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.