Eagle Rock Dental Care
Organization Active NPI General Practice Dentistry · Idaho Falls, ID
NPI 1356465660 · NPPES record last updated Feb 3, 2014
Key facts
- NPI
- 1356465660
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D-1297 (ID)
- Legal business name
- EAGLE ROCK DENTAL CARE
- Practice address
- 640 S Woodruff Ave
Idaho Falls, ID 83401-5299 - Phone
- (208) 523-5400
- Fax
- (208) 528-0565
- NPI assigned
- Mar 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Trudee L Chapple
- Title
- Administrator
- Phone
- (208) 523-5400
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 6
-
Cade Grimmett Baldwin, D.D.S.
-
Douglas Steven Barnard, D.D.S.
-
Steven Abbott Barnard, D.D.S.
-
Alan Ray Cooper, D.D.S.
-
Blaine A Hammond, DMD
-
Nicholas J Tanner, D.D.S.
National Provider Directory
- Tax ID family
- Eagle Rock Dental Care PLLC
Locations
640 S Woodruff Ave
Idaho Falls, ID 83401
Phone (208) 522-2922
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | D-3271 | ID | |
| General Practice Dentistry |
1223G0001X | D-1297 | ID | Yes |
| General Practice Dentistry |
1223G0001X | D-3063 | ID | |
| General Practice Dentistry |
1223G0001X | D-1890 | ID | |
| General Practice Dentistry |
1223G0001X | D4138 | ID |
Addresses
Primary practice location
640 S Woodruff Ave
Idaho Falls, ID 83401-5299
Mailing address
640 S Woodruff Ave
Idaho Falls, ID 83401-5299
Phone (208) 523-5400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D4138 | Other | ID | ISDA |
Other providers in Idaho Falls, ID
- Sydney June Dustin
- DVT Solutions LLC
- Janae Lynn Dye
- Eagle Rock Anesthesia PLLC
- Eagle Rock Anesthesia, PLLC
- Eagle Rock Dental Care PLLC
- Eagle Rock Medical Center LLC
- Eagle Rock Physical Therapy
- Eagle Rock Physical Therapy PLLC
- Eagle Rock Regional Neurology, P.C.
All providers in Idaho Falls, ID · General Practice Dentistry in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2014. 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.