Center for Dental Excellence LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D3808 Issued in ID

Legal business name

CENTER FOR DENTAL EXCELLENCE LLC

Practice address

1525 Baldy Ave
Pocatello, ID 83201-7117

Phone

(208) 238-0011

Fax

(208) 904-3843

NPI assigned

Sep 30, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Jeremy L Hodge, DMD

Title

Owner

Phone

(208) 238-0011

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1285804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1376852939",
    "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",
            "telephone_number": "208-238-0011",
            "fax_number": "208-904-3843"
        },
        {
            "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",
            "fax_number": "208-904-3843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR DENTAL EXCELLENCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-30",
        "last_updated": "2010-11-18",
        "status": "A",
        "authorized_official_last_name": "HODGE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-238-0011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D3808",
            "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 Nov 18, 2010; 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.