Individual provider Active NPI

David J Bingham, DDS

  • Dentist
  • Idaho Falls, ID
National Provider Identifier
1649925561
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D-5387 Issued in ID
Practice address
3335 S Holmes Ave
Idaho Falls, ID 83404-7981
Phone
(208) 524-3770
NPI assigned
Feb 18, 2022
Last updated
Feb 18, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D-5387 ID Primary

Addresses

Primary practice location

3335 S Holmes Ave
Idaho Falls, ID 83404-7981

Mailing address

2535 N 4000 W
Dayton, ID 83232-5134
Phone (208) 851-0618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231214003205 ID Order and Referring Only - DentistPractitioner - Dentist 1052760162

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D-5387IDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Root & Branch Anesthesia P.L.L.C. CurrentSince Jan 19, 2025 Accepting new patients
Eastern Idaho Endodontics PastSince Feb 24, 2022 Accepting new patients

Locations

3335 S Holmes Ave
Idaho Falls, ID 83404
Phone (208) 524-3770

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1645142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645142400000",
    "number": "1649925561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 N 4000 W",
            "city": "DAYTON",
            "state": "ID",
            "postal_code": "832325134",
            "telephone_number": "208-851-0618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3335 S HOLMES AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047981",
            "telephone_number": "208-524-3770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BINGHAM",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-18",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-5387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.