NPIMap

Organization Active NPI

Channing Way Dental Care

  • General Practice Dentistry
  • Idaho Falls, ID
National Provider Identifier
1376555292
Registry record updated Mar 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CHANNING WAY DENTAL CARE
Practice address
2205 Channing Way
Suite B
Idaho Falls, ID 83404-8016
Phone
(208) 529-3660
Fax
(208) 529-3666
NPI assigned
Aug 12, 2006
Last updated
Mar 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2008

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

Authorized official

Name
Dr. Glade L. Peterson, D.M.D.
Title
Owner/Partner
Phone
(208) 529-3660

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

2205 Channing Way
Suite B
Idaho Falls, ID 83404-8016

Mailing address

2205 Channing Way
Suite B
Idaho Falls, ID 83404-8016
Phone (208) 529-3660

National Provider Directory

National Provider Directory
Tax ID family
Channing Way Dental Care2 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.

Locations

2205 Channing Way
Ste B
Idaho Falls, ID 83404
Phone (208) 527-3660

Practitioners & affiliated clinicians

Practitioners 2

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": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1376555292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 CHANNING WAY",
            "address_2": "SUITE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048016",
            "telephone_number": "208-529-3660",
            "fax_number": "208-529-3666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 CHANNING WAY",
            "address_2": "SUITE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048016",
            "telephone_number": "208-529-3660",
            "fax_number": "208-529-3666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANNING WAY DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "GLADE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "208-529-3660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "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 Mar 25, 2008; 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.