Active NPI
Conrad Chase Trimble
- General Practice Dentistry
- Mountain Home Afb, ID
National Provider Identifier
1639907231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10844
- Practice address
- 90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062 - Phone
- (208) 828-7300
- NPI assigned
- Jul 24, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10844 | SC | Primary |
Addresses
Primary practice location
90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062
Mailing address
90 Hope Dr BLDG 6000
Mountain Home Afb, ID 83648-1062
Phone (208) 828-7300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10844 | SC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757894400000",
"number": "1639907231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 HOPE DR BLDG 6000",
"city": "MOUNTAIN HOME AFB",
"state": "ID",
"postal_code": "836481062",
"telephone_number": "208-828-7300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 HOPE DR BLDG 6000",
"city": "MOUNTAIN HOME AFB",
"state": "ID",
"postal_code": "836481062",
"telephone_number": "208-828-7300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRIMBLE",
"first_name": "CONRAD",
"middle_name": "CHASE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-24",
"last_updated": "2025-09-15",
"certification_date": "2025-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "10844",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home Afb, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.