NPIMap

Organization Active NPI

Andrea S Radabaugh DDS PLLC

  • Dentist
  • Craigmont, ID
National Provider Identifier
1811281397
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D4296 Issued in ID
Legal business name
ANDREA S RADABAUGH DDS PLLC
Practice address
420 Division Ave
Craigmont, ID 83523
Phone
(208) 924-5830
NPI assigned
Jun 2, 2011
Last updated
Jun 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

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

Authorized official

Name
Dr. Andrea S Radabaugh, DDS
Title
Owner Dentist
Phone
(530) 333-7853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D4296 ID Primary

Addresses

Primary practice location

420 Division Ave
Craigmont, ID 83523

Mailing address

PO Box 218
Craigmont, ID 83523-0218
Phone (530) 333-7853

National Provider Directory

National Provider Directory

Locations

420 N Division Ave
Craigmont, ID 83523
Phone (208) 924-5830

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308614400000",
    "number": "1811281397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "CRAIGMONT",
            "state": "ID",
            "postal_code": "835230218",
            "telephone_number": "530-333-7853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DIVISION AVE",
            "city": "CRAIGMONT",
            "state": "ID",
            "postal_code": "83523",
            "telephone_number": "208-924-5830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREA S RADABAUGH DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "last_updated": "2011-06-21",
        "status": "A",
        "authorized_official_last_name": "RADABAUGH",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "530-333-7853",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D4296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Craigmont, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; 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.