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

Last updated

Jun 5, 2008By 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

Mr. Shon D Rooks, D.D.S.NPI 1376592337

Title

President

Phone

(208) 365-3860

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shon Dewane Rooks, D.D.S.

  • General Practice Dentistry
  • Emmett, ID
  • NPI 1376592337
  Authorized official Same address or phone

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
• Andrea Bowhay

• General Practice Dentistry in Emmett, ID
• Providers in Emmett, ID by specialty
• 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.