Eagle Rock Dental Care PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3063 Issued in ID

Legal business name

EAGLE ROCK DENTAL CARE PLLC

Practice address

2205 Channing Way Ste B
Idaho Falls, ID 83404-8016

Phone

(208) 529-3660

Fax

(208) 529-3666

NPI assigned

Aug 9, 2012

Organization subpart

Yes

Parent organization

EAGLE ROCK DENTAL CARE PLLCAs reported in NPPES

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

Authorized official

Name

Trudee L Chapple

Title

Office Administrator

Phone

(208) 523-5400

Specialties & licenses 6

Addresses

Tax ID family

Eagle Rock Dental Care PLLC2 organizations share this tax ID, including this one

Part of

Eagle Rock Dental Care PLLC

Other organizations with this tax ID 1

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

• Eagle Rock Dental Care

  • General Practice Dentistry
  • Idaho Falls, ID
  • NPI 1356465660
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Eagle Rock Dental Care

  • General Practice Dentistry
  • Idaho Falls, ID
  • NPI 1356465660
  NPPES parent name

Practitioners 2

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

• Jeffrey A. Hoover, D.M.D.

  • General Practice Dentistry
  • Idaho Falls, ID
  • NPI 1306915046
  NPD (past)
• Justin Thomas Peterson, D.D.S.

  • General Practice Dentistry
  • Saint Anthony, ID
  • NPI 1386955029
  NPD (past)

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345766400000",
    "number": "1326395385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 CHANNING WAY STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048016",
            "telephone_number": "208-529-3660",
            "fax_number": "208-529-3666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 CHANNING WAY STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048016",
            "telephone_number": "208-529-3660",
            "fax_number": "208-529-3666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE ROCK DENTAL CARE PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLE ROCK DENTAL CARE PLLC",
        "enumeration_date": "2012-08-09",
        "last_updated": "2012-08-24",
        "status": "A",
        "authorized_official_last_name": "CHAPPLE",
        "authorized_official_first_name": "TRUDEE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "208-523-5400"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3063",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4138",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1890",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4036",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4369",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1608",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• DVT Solutions LLC
• Janae Lynn Dye, CRT
• Eagle Rock Anesthesia PLLC
• Eagle Rock Anesthesia, PLLC
• Eagle Rock Dental Care
• Eagle Rock Medical Center LLC
• Eagle Rock Physical Therapy
• Eagle Rock Physical Therapy PLLC
• Eagle Rock Regional Neurology, P.C.
• Mark Allen Eames, COTA

• 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 Aug 24, 2012; 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.