Black Canyon Dental P C

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BLACK CANYON DENTAL P C

Practice address

1110 S Washington Ave
Emmett, ID 83617-3535

Phone

(208) 365-3860

NPI assigned

Jun 3, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Shon D Rooks, D.D.S.

Title

President

Phone

(208) 365-3860

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1679732804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 S WASHINGTON AVE",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836173535",
            "telephone_number": "208-365-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 S WASHINGTON AVE",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836173535",
            "telephone_number": "208-365-3860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK CANYON DENTAL P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "ROOKS",
        "authorized_official_first_name": "SHON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-365-3860",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Bret Barrus, D.O.
• Zachary N Bastian, MD
• Alan Robert Benson, CRNA
• Amber Mechelle Berger, PMHNP-BC
• Malerie Erin Bettfreund, LMSW
• Black Canyon Family Medicine PC
• Black Canyon Medical Group PLLC
• Reece Arthur Bodam
• Kahn Borge, LMSW
• Ted Roby Bost III, LPC

• All providers in Emmett, ID
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; 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.