Affordable Family Dentistry PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-4216 Issued in ID

Legal business name

AFFORDABLE FAMILY DENTISTRY PC

Practice address

1400 E 17TH St
Idaho Falls, ID 83404-6269

Phone

(208) 881-9177

Fax

(866) 767-0878

NPI assigned

Jan 4, 2010

Last updated

Oct 20, 2023By 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. Tracy Dean Jenkins, DDSNPI 1659507481

Title

President

Phone

(208) 881-9177

Specialties & licenses 1

Addresses

Locations

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.

• Tracy Dean Jenkins, D.D.S.

  • General Practice Dentistry
  • Idaho Falls, ID
  • NPI 1659507481
  NPD Authorized official

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

{
    "created_epoch": "1262563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1245560945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046269",
            "telephone_number": "208-881-9177",
            "fax_number": "866-767-0878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046269",
            "telephone_number": "208-881-9177",
            "fax_number": "866-767-0878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFORDABLE FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-04",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-881-9177",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-4216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Oct 20, 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.

Verify at the official NPI Registry.