NPIMap

Organization Active NPI

Idaho Falls Dental Group

  • Dentist
  • Idaho Falls, ID
National Provider Identifier
1497803696
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
IDAHO FALLS DENTAL GROUP
Practice address
2300 E 17TH St
Idaho Falls, ID 83404-6504
Phone
(208) 525-8383
Fax
(208) 523-6419
NPI assigned
Jan 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Tracy Larsen
Title
Office Manager
Phone
(208) 525-8383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

2300 E 17TH St
Idaho Falls, ID 83404-6504

Mailing address

PO Box 2046
Idaho Falls, ID 83403-2046
Phone (208) 525-8383

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497803696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2046",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834032046",
            "telephone_number": "208-525-8383",
            "fax_number": "208-523-6419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046504",
            "telephone_number": "208-525-8383",
            "fax_number": "208-523-6419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO FALLS DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-525-8383"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "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 Aug 22, 2020; 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.