NPIMap

Organization Active NPI

Eagle Oral Surgery and Dental Implant Center PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Eagle, ID
National Provider Identifier
1780074864
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
D-4617-OS Issued in ID
Legal business name
EAGLE ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC
Practice address
197 W State St
Eagle, ID 83616-4959
Phone
(208) 995-2865
NPI assigned
Jan 28, 2015
Last updated
Jan 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

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

Authorized official

Name
Jeremy L Hixson, DMD
Title
Owner/Provider
Phone
(208) 451-6584

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X D-4617-OS ID Primary

Addresses

Primary practice location

197 W State St
Eagle, ID 83616-4959

Mailing address

197 W State St
Eagle, ID 83616-4959
Phone (208) 995-2865

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1780074864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "197 W STATE ST",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164959",
            "telephone_number": "208-995-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 W STATE ST",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836164959",
            "telephone_number": "208-995-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-28",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "HIXSON",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "208-451-6584",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D-4617-OS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; 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.