NPIMap

Organization Active NPI

Care Creek Dental LLC

  • General Practice Dentistry
  • Pocatello, ID
National Provider Identifier
1326281163
Registry record updated Apr 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-3946 Issued in ID
Legal business name
CARE CREEK DENTAL LLC
Practice address
1169 Call Creek Dr Ste a
Pocatello, ID 83201-3077
Phone
(208) 233-8620
NPI assigned
Apr 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2009

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

Authorized official

Name
Dr. Paul A. Gagnon, DMDNPI 1699811463
Title
Dentist/Owner
Phone
(208) 233-8620

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D-3946 ID Primary

Addresses

Primary practice location

1169 Call Creek Dr Ste a
Pocatello, ID 83201-3077

Mailing address

1169 Call Creek Dr Ste a
Pocatello, ID 83201-3077
Phone (208) 233-8620

National Provider Directory

National Provider Directory

Locations

1169 Call Creek Dr
Ste A
Pocatello, ID 83201
Phone (208) 233-8620

Practitioners & affiliated clinicians

Practitioners 1

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": "1239235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239235200000",
    "number": "1326281163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1169 CALL CREEK DR STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013077",
            "telephone_number": "208-233-8620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1169 CALL CREEK DR STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013077",
            "telephone_number": "208-233-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARE CREEK DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-09",
        "last_updated": "2009-04-09",
        "status": "A",
        "authorized_official_last_name": "GAGNON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "208-233-8620",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2009; 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.