The Family Dental Center, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3613 Issued in ID

Legal business name

THE FAMILY DENTAL CENTER, PLLC

Practice address

625 W Bridge St
Blackfoot, ID 83221-2018

Phone

(208) 785-2685

Fax

(208) 785-0998

NPI assigned

Jul 16, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Karen J. Pruett

Title

Office Manager

Phone

(208) 785-2685

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Paul Lloyd Hansen, D.D.S.

  • Dentist
  • Blackfoot, ID
  • NPI 1831415447
  NPD (past)

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538186366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832210458",
            "telephone_number": "208-785-2685",
            "fax_number": "208-785-0998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 W BRIDGE ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212018",
            "telephone_number": "208-785-2685",
            "fax_number": "208-785-0998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FAMILY DENTAL CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PRUETT",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-785-2685",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ashley Nichole Thomas, PA-C
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• General Practice Dentistry in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• General Practice Dentistry in Idaho

• 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.