Active NPI
Brent William Cline
- Dentist
- Pocatello, ID
National Provider Identifier
1487148979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D4930
- Practice address
- 675 Yellowstone Ave
Pocatello, ID 83201-4511 - Phone
- (208) 478-5700
- NPI assigned
- Jun 18, 2018
- Last updated
- Jun 18, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D4930 | ID | Primary |
Addresses
Primary practice location
675 Yellowstone Ave
Pocatello, ID 83201-4511
Mailing address
467 Pheasant Ridge Dr Apt B
Pocatello, ID 83202-1755
Phone (208) 201-5780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D4930 | ID | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brent Cline DDS PLLC | Current | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529280000000",
"number": "1487148979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "467 PHEASANT RIDGE DR APT B",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832021755",
"telephone_number": "208-201-5780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 YELLOWSTONE AVE",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014511",
"telephone_number": "208-478-5700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLINE",
"first_name": "BRENT",
"middle_name": "WILLIAM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-18",
"last_updated": "2018-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ID",
"license": "D4930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.