NPIMap

Organization Active NPI

Elkridge Dental South LLC

  • Dental Clinic/Center
  • Jackson, WY
National Provider Identifier
1538822374
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
ELKRIDGE DENTAL SOUTH LLC
Practice address
1315 S Hwy 89
Jackson, WY 83001-8514
Phone
(307) 733-4122
NPI assigned
Oct 19, 2021
Last updated
Oct 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Authorized official

Name
Nathan TannerNPI 1326181579
Title
President
Phone
(503) 866-8454

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

1315 S Hwy 89
Jackson, WY 83001-8514

Mailing address

PO Box 1190
Jackson, WY 83001-1190
Phone (307) 733-2555

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Jackson Direct

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": "1634601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634601600000",
    "number": "1538822374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1190",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830011190",
            "telephone_number": "307-733-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 S HWY 89",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018514",
            "telephone_number": "307-733-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELKRIDGE DENTAL SOUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-19",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-866-8454"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Jackson",
            "affiliation": "N",
            "endpointDescription": "office",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1315 S Hwy 89",
            "city": "Jackson",
            "state": "WY",
            "country_code": "US",
            "postal_code": "830018514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; 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.