Carl Call
Individual provider Active NPI Dentist · Malad City, ID
NPI 1336038355 · NPPES record last updated Jul 10, 2025
Key facts
- NPI
- 1336038355
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6671966 (ID)
- Practice address
- 185 S 300 E
Malad City, ID 83252-1343 - Phone
- (208) 766-2204
- NPI assigned
- Jul 2, 2025
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6671966 | ID | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Malad Valley Dental Clinic LLC | Dentist | Current |
Accepting new patients |
Locations
185 S 300 E
Malad City, ID 83252
Phone (208) 766-2204
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6671966 | ID | Yes |
Addresses
Primary practice location
185 S 300 E
Malad City, ID 83252-1343
Mailing address
290 E 100 S
Willard, UT 84340-9739
Phone (435) 720-0832
Other providers in Malad City, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.