Image Dental Eagle LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

IMAGE DENTAL EAGLE LLC

Practice address

56 Market St
Suite #5
Eagle, CO 81631

Phone

(970) 328-1116

Fax

(970) 328-0524

NPI assigned

Apr 3, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Amy A Meryhew, RDH

Title

Partner

Phone

(970) 328-1116

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609997675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 576",
            "city": "EAGLE",
            "state": "CO",
            "postal_code": "816310576",
            "telephone_number": "970-328-1116",
            "fax_number": "970-328-0524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 MARKET ST",
            "address_2": "SUITE #5",
            "city": "EAGLE",
            "state": "CO",
            "postal_code": "81631",
            "telephone_number": "970-328-1116",
            "fax_number": "970-328-0524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMAGE DENTAL EAGLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MERYHEW",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "970-328-1116",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.