Individual provider Active NPI

Justin Frandsen, DDS

  • General Practice Dentistry
  • Idaho Falls, ID
National Provider Identifier
1407085467
Registry record updated Aug 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-4223 Issued in ID
Practice address
3375 Merlin Dr
Idaho Falls, ID 83404-7405
Phone
(208) 524-1700
Fax
(208) 524-1702
NPI assigned
Jul 10, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D-4223 ID Primary

Addresses

Primary practice location

3375 Merlin Dr
Idaho Falls, ID 83404-7405

Mailing address

3375 Merlin Dr
Idaho Falls, ID 83404-7405
Phone (208) 524-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160115001290 ID Order and Referring Only - DentistPractitioner - Dentist 2062715568

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D-4223IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Falls Smiles, PLLC General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1407085467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3375 MERLIN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047405",
            "telephone_number": "208-524-1700",
            "fax_number": "208-524-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3375 MERLIN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047405",
            "telephone_number": "208-524-1700",
            "fax_number": "208-524-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRANDSEN",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-10",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-4223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.