Joshua Price Wray
Individual provider Active NPI Dentist · Malad City, ID
NPI 1689304529 · NPPES record last updated Jun 14, 2022
Key facts
- NPI
- 1689304529
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D-5426 (ID)
- Practice address
- 150 S Main St
Malad City, ID 83252-1405 - Phone
- (208) 905-3614
- NPI assigned
- Jun 14, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-5426 | ID | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cedar Hills Family Dentistry | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D-5426 | ID | Yes |
Addresses
Primary practice location
150 S Main St
Malad City, ID 83252-1405
Mailing address
150 S Main St
Malad City, ID 83252-1405
Phone (208) 905-3614
Other practice location 1
1525 Bannock Hwy
Pocatello, ID 83204-3509
Phone (208) 233-2230
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D-5462 | Other | ID | LICENSE NUMBER |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | info@oneidafamilydental.com | Direct |
Other providers in Malad City, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.