Facial Trauma Associates PLLC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

FACIAL TRAUMA ASSOCIATES PLLC

Practice address

1000 N Curtis Rd Ste 103
Boise, ID 83706-1345

Phone

(208) 343-0909

NPI assigned

Feb 14, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Cole W Anderson, DMD

Title

Member

Phone

(208) 343-0909

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1581638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1568095883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N CURTIS RD STE 103",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061345",
            "telephone_number": "208-343-0909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N CURTIS RD STE 103",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061345",
            "telephone_number": "208-343-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACIAL TRAUMA ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-14",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "COLE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "208-343-0909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eyes of Idaho PC
• Carolyn Eyre
• Nikki A Eytchison
• F. Alan Walker, DMD, PC
• Alison Lorraine Faber, AU.D.
• Tom Faciszewski, MD
• Wendell Fackrell, O.D.
• Anna Faffler, LPC
• Pamela Fagan, M.A., LCPC
• Brianne M Fagenstrom, LMSW

• All providers in Boise, ID
• Oral & Maxillofacial Surgery (D.M.D.) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.