Active NPI
Rufus Van Dyke III, DDS, MCL.D
- Orthodontics and Dentofacial Orthopedics Dentistry
- Pocatello, ID
National Provider Identifier
1780604702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- D-3206-OR
- Practice address
- 1501 Bench Rd
Pocatello, ID 83201-2443 - Phone
- (208) 237-3330
- Fax
- (208) 237-3347
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | D-3206-OR | ID | Primary |
Addresses
Primary practice location
1501 Bench Rd
Pocatello, ID 83201-2443
Mailing address
1501 Bench Road
Pocatello, ID 83201-2443
Phone (208) 237-3330
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-3206-OR | ID | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780604702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 BENCH ROAD",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832012443",
"telephone_number": "208-237-3330",
"fax_number": "208-237-3347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 BENCH RD",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832012443",
"telephone_number": "208-237-3330",
"fax_number": "208-237-3347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DYKE",
"first_name": "RUFUS",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS, MCL.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "ID",
"license": "D-3206-OR",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.