NPIMap

Organization Active NPI

Magic Valley Family Dental

  • General Practice Dentistry
  • Rupert, ID
National Provider Identifier
1477723955
Registry record updated Mar 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3903 Issued in ID
Legal business name
MAGIC VALLEY FAMILY DENTAL
Practice address
115 W 100 S
Rupert, ID 83350-9125
Phone
(208) 436-4532
NPI assigned
Mar 11, 2008
Last updated
Mar 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2008

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

Authorized official

Name
Denise J Mallory
Title
Office Manager
Phone
(208) 436-4532

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D3903 ID Primary

Addresses

Primary practice location

115 W 100 S
Rupert, ID 83350-9125

Mailing address

115 W 100 S
Rupert, ID 83350-9125
Phone (208) 436-4532

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1477723955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W 100 S",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833509125",
            "telephone_number": "208-436-4532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W 100 S",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833509125",
            "telephone_number": "208-436-4532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGIC VALLEY FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "MALLORY",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-436-4532"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rupert, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.