Backcountry Dental Docs, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

BACKCOUNTRY DENTAL DOCS, LLC

Practice address

109 McKinley Ave
Kellogg, ID 83837-2501

Phone

(208) 784-0545

NPI assigned

Jun 26, 2019

Last updated

Oct 3, 2022By 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

Dr. Hillary Anne Berry, DMDNPI 1396800033

Title

Manager

Phone

(425) 409-1655

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

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.

• Hillary Anne Berry, DMD

  • General Practice Dentistry
  • Kellogg, ID
  • NPI 1396800033
  NPD Authorized official

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

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1235790510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2691 E THOMAS HILL DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838156335",
            "telephone_number": "425-409-1655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 MCKINLEY AVE",
            "city": "KELLOGG",
            "state": "ID",
            "postal_code": "838372501",
            "telephone_number": "208-784-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACKCOUNTRY DENTAL DOCS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-26",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "HILLARY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "425-409-1655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21014",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hillary@backcountrydmd.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "109 McKinley Ave",
            "city": "Kellogg",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838372501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Jennifer Backman, DO
• Dakota Rex Baker, DDS
• Lyndell Corin Baser, PHARMD
• Hillary Anne Berry, DMD
• Ashten Berti, MSN,FNP-C

• Dentist in Kellogg, ID
• Providers in Kellogg, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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.