NPIMap

Organization Active NPI

Eagle Rock Dental Care

  • General Practice Dentistry
  • Idaho Falls, ID
National Provider Identifier
1356465660
Registry record updated Feb 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-1297 Issued in 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
Last updated
Feb 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2014

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

Authorized official

Name
Trudee L Chapple
Title
Administrator
Phone
(208) 523-5400

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X D-3271 ID
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D-1297 ID Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D-3063 ID
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X D-1890 ID
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 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

National Provider Directory

National Provider Directory
Tax ID family
Eagle Rock Dental Care PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1356465660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015299",
            "telephone_number": "208-523-5400",
            "fax_number": "208-528-0565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015299",
            "telephone_number": "208-523-5400",
            "fax_number": "208-528-0565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE ROCK DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "CHAPPLE",
        "authorized_official_first_name": "TRUDEE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-523-5400"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-3271",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-1297",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3063",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-1890",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4138",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.