NPIMap

Organization Active NPI

Two Rivers Family & Cosmetic Dentistry, PA

  • General Practice Dentistry
  • McCall, ID
National Provider Identifier
1821380346
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3076 Issued in ID
Legal business name
TWO RIVERS FAMILY & COSMETIC DENTISTRY, PA
Practice address
307 E Park St Ste 103
McCall, ID 83638-3863
Phone
(208) 634-5255
Fax
(208) 634-1047
NPI assigned
May 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Authorized official

Name
Claudette Kim Meyer
Title
Office Manger
Phone
(208) 634-5255

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D3076 ID Primary
Dental Clinic/Center 261QD0000X

Addresses

Primary practice location

307 E Park St Ste 103
McCall, ID 83638-3863

Mailing address

307 E Park St
Suite 203
McCall, ID 83638-3863
Phone (208) 634-5255

Other identifiers 1

IdentifierTypeStateIssuer
M8074016MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Two Rivers Family Cosmetic Dentistry PA4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668470400000",
    "number": "1821380346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 E PARK ST",
            "address_2": "SUITE 203",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836383863",
            "telephone_number": "208-634-5255",
            "fax_number": "208-634-1047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 E PARK ST STE 103",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836383863",
            "telephone_number": "208-634-5255",
            "fax_number": "208-634-1047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWO RIVERS FAMILY & COSMETIC DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-03",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "CLAUDETTE",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "OFFICE MANGER",
        "authorized_official_telephone_number": "208-634-5255"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3076",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M8074016",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McCall, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; 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.