NPIMap

Organization Active NPI

Famliy Dental Health Center

Doing business as Burtenshaw Craig A & G Staley GPS

  • Dentist
  • Idaho Falls, ID
National Provider Identifier
1679745269
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D3064 Issued in ID
Legal business name
FAMLIY DENTAL HEALTH CENTER
Doing business as
Burtenshaw Craig A & G Staley GPS
Practice address
200 N Woodruff Ave
Idaho Falls, ID 83401-4334
Phone
(208) 529-0120
NPI assigned
Mar 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

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

Authorized official

Name
Dr. Galen Jay Staley, DDSNPI 1821047432
Title
Partner
Phone
(208) 529-0120

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D1628 ID
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D3064 ID Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D3614 ID
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X D3038 ID

Addresses

Primary practice location

200 N Woodruff Ave
Idaho Falls, ID 83401-4334

Mailing address

200 N Woodruff Ave
Idaho Falls, ID 83401-4334
Phone (208) 529-0120

Other identifiers 4

IdentifierTypeStateIssuer
806335900MedicaidID
806939100MedicaidID
02740700MedicaidID
00274600MedicaidID

Other names 1

  • Burtenshaw Craig A & G Staley GPS Doing business as

National Provider Directory

National Provider Directory

Locations

200 N Woodruff Ave
Idaho Falls, ID 83401
Phone (208) 529-0120

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1679745269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014334",
            "telephone_number": "208-529-0120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014334",
            "telephone_number": "208-529-0120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMLIY DENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "STALEY",
        "authorized_official_first_name": "GALEN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "208-529-0120",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D1628",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3064",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3614",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3038",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806335900",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806939100",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02740700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00274600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Burtenshaw Craig A & G Staley GPS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.