Portneuf Valley Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PORTNEUF VALLEY DENTAL

Practice address

1246 Yellowstone Ave
Pocatello, ID 83201-4374

Phone

(208) 238-0125

NPI assigned

Nov 5, 2019

Organization subpart

No

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

Authorized official

Name

Jayson Anders Bird, DDS

Title

Ceo/Owner

Phone

(208) 680-5144

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572912000000",
    "number": "1770127565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1246 YELLOWSTONE AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014374",
            "telephone_number": "208-238-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 YELLOWSTONE AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014374",
            "telephone_number": "208-238-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTNEUF VALLEY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-05",
        "last_updated": "2019-11-05",
        "status": "A",
        "authorized_official_last_name": "BIRD",
        "authorized_official_first_name": "JAYSON",
        "authorized_official_middle_name": "ANDERS",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "208-680-5144",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portneuf Medical Center
• Portneuf Medical Center
• Portneuf Medical Center
• Portneuf Nephrology Center
• Portneuf River Center
• Portneuf Valley Family Center
• Portneuf Valley Family Center
• Portneuf Valley Family Center
• Elizabeth Poteat
• Charity Potter, LCPC, LSW

• Dental Clinic/Center in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; 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.