Potlatch Family Dental, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3984 Issued in ID

Legal business name

POTLATCH FAMILY DENTAL, PC

Practice address

225 6TH Street
Potlatch, ID 83855

Phone

(208) 875-0441

Fax

(208) 875-0972

NPI assigned

Oct 15, 2011

Last updated

Oct 15, 2011By 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. Ammon Michael Pitt, D.D.S.

Title

Dentist

Phone

(208) 875-0441

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1318636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318636800000",
    "number": "1245515832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601",
            "city": "POTLATCH",
            "state": "ID",
            "postal_code": "838550601",
            "telephone_number": "208-875-0441",
            "fax_number": "208-875-0972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 6TH STREET",
            "city": "POTLATCH",
            "state": "ID",
            "postal_code": "83855",
            "telephone_number": "208-875-0441",
            "fax_number": "208-875-0972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTLATCH FAMILY DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-15",
        "last_updated": "2011-10-15",
        "status": "A",
        "authorized_official_last_name": "PITT",
        "authorized_official_first_name": "AMMON",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-875-0441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8075010",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northwest Clinical Services
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• Palouse Ridge Occupational Therapy PLLC
• Suzanne Paul, M.D.
• Potlatch Rural Fire Dist
• Anne M White, LICSW
• Skyler S Worthington, PA-C

• General Practice Dentistry in Potlatch, ID
• Providers in Potlatch, 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 Oct 15, 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.