NPIMap

Organization Active NPI

JC Dentistry LLC

  • General Practice Dentistry
  • Cheyenne, WY
National Provider Identifier
1689117608
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1416 Issued in WY
Legal business name
JC DENTISTRY LLC
Doing business as
Brookside Dental
Practice address
229 Storey Blvd Ste a
Cheyenne, WY 82009-3595
Phone
(307) 635-6300
Fax
(307) 635-6361
NPI assigned
Nov 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

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

Authorized official

Name
Dr. Jared B Christopherson, DDSNPI 1164804589
Title
Owner
Phone
(307) 635-6300

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 1416 WY Primary

Addresses

Primary practice location

229 Storey Blvd Ste a
Cheyenne, WY 82009-3595

Mailing address

229 Storey Blvd Ste a
Cheyenne, WY 82009-3595
Phone (307) 635-6300

Other names 1

  • Brookside Dental Doing business as

National Provider Directory

National Provider Directory

Locations

229 Storey Blvd
Ste A
Cheyenne, WY 82009
Phone (307) 635-6300

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1689117608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 STOREY BLVD STE A",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820093595",
            "telephone_number": "307-635-6300",
            "fax_number": "307-635-6361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 STOREY BLVD STE A",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820093595",
            "telephone_number": "307-635-6300",
            "fax_number": "307-635-6361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-22",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "CHRISTOPHERSON",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-635-6300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WY",
            "license": "1416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cheyenne, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; 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.