Advanced Family Dentistry PC – Dentist in Nampa, ID

Key facts

NPI: 1790796134
Entity type: Organization (NPI type 2)
Primary specialty: Dentist 122300000X
License: D3047 (ID)
Legal business name: ADVANCED FAMILY DENTISTRY PC
Practice address: 1603-D 12TH Ave Rd
Nampa, ID 83686
Phone: (208) 468-0590
Fax: (208) 468-9910
NPI assigned: Aug 10, 2006
Organization subpart: No

Authorized official

Name: Dr. Marco Vinicio Galvez, DDS
Title: President
Phone: (208) 468-0590

National Provider Directory

Locations

1603 12th Ave Rd
Ste D
Nampa, ID 83686
Phone (208) 468-0590

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist Group: 193400000X SINGLE SPECIALTY GROUP	122300000X	D3047	ID	Yes

Addresses

Primary practice location

1603-D 12TH Ave Rd
Nampa, ID 83686

Mailing address

1603-D 12TH Ave Rd
Nampa, ID 83686
Phone (208) 468-0590

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790796134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1603-D 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "83686",
            "telephone_number": "208-468-0590",
            "fax_number": "208-468-9910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603-D 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "83686",
            "telephone_number": "208-468-0590",
            "fax_number": "208-468-9910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GALVEZ",
        "authorized_official_first_name": "MARCO",
        "authorized_official_middle_name": "VINICIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-468-0590",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

All providers in Nampa, ID · Dentist in Idaho

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.

Verify at the official NPI Registry.