NPIMap

Organization Active NPI

Foothills Dental Care

  • Dental Clinic/Center
  • Idaho Falls, ID
National Provider Identifier
1275619090
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D1719 Issued in ID
Legal business name
FOOTHILLS DENTAL CARE
Practice address
2205 Channing Way
Suite a
Idaho Falls, ID 83404-8016
Phone
(208) 529-4484
Fax
(208) 523-4441
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Wayne Bernell Murdock, DDSNPI 1952317703
Title
Owner/Partner
Phone
(208) 529-4484

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X D1719 ID Primary

Addresses

Primary practice location

2205 Channing Way
Suite a
Idaho Falls, ID 83404-8016

Mailing address

3955 Georgia LN
Ammon, ID 83406-7812
Phone (208) 529-0868

National Provider Directory

National Provider Directory
Tax ID family
Foothills Dental Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275619090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 GEORGIA LN",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834067812",
            "telephone_number": "208-529-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 CHANNING WAY",
            "address_2": "SUITE A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048016",
            "telephone_number": "208-529-4484",
            "fax_number": "208-523-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MURDOCK",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "BERNELL",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "208-529-4484",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D1719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.