Andrew Stoddard Dental Services, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D-4149 Issued in ID

Legal business name

ANDREW STODDARD DENTAL SERVICES, PLLC

Practice address

1525 Baldy Ave
Pocatello, ID 83201-7117

Phone

(208) 238-0011

NPI assigned

Jun 4, 2012

Last updated

Jun 4, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Andrew Stoddard, DDS

Title

Sole Member

Phone

(208) 238-0011

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1338768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338768000000",
    "number": "1346501657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 BALDY AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832017117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 BALDY AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832017117",
            "telephone_number": "208-238-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREW STODDARD DENTAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-04",
        "last_updated": "2012-06-04",
        "status": "A",
        "authorized_official_last_name": "STODDARD",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "208-238-0011",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D-4149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.