G. Van Stosich, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-1730 Issued in ID

Practice address

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

Phone

(208) 522-8061

Fax

(208) 522-8061

NPI assigned

Oct 26, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Zimbi Dental PLLC

  • Dental Clinic/Center
  • Idaho Falls, ID
  • NPI 1407355092
  NPD (past)

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1336224633",
    "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": "208-522-8061",
            "fax_number": "208-522-8061"
        },
        {
            "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": "208-522-8061",
            "fax_number": "208-522-8061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOSICH",
        "first_name": "G.",
        "middle_name": "VAN",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-1730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID",
            "identifier": "6F233",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST LICENSE #",
            "identifier": "D-1730",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Blake Stoker
• Matthew Gregory Stokes, BA
• Trena Kirsten Stoneman
• Jodie Kaye Stookey, APRN-CNP
• Charles Todd Storms, RPT
• Angela Stott, CADC
• Kimberly Dawn Stowell, M.S., CCC-SLP
• Richard Joseph Strachan, PHARMD
• Strada Performance LLC
• Lettie Stradley-Bass, LCPC-8478

• 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 Mar 7, 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.