Michael Jangula

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4595 Issued in ID

Practice address

672 E Wythe Creek CT Ste 101
Kuna, ID 83634-5216

Phone

(208) 629-2800

NPI assigned

Aug 6, 2014

Last updated

Aug 6, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Avalon Dental PC

  • Dental Clinic/Center
  • Kuna, ID
  • NPI 1962850933
  NPD (past)
• Brigham Murray Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Kuna, ID
  • NPI 1558872598
  NPD (past)

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

{
    "created_epoch": "1407283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407283200000",
    "number": "1821407552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 W TROPHY ST",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836343310",
            "telephone_number": "208-412-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "672 E WYTHE CREEK CT STE 101",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836345216",
            "telephone_number": "208-629-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANGULA",
        "first_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-06",
        "last_updated": "2014-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Id Specialty Dental Services, PLLC
• Idaho Dental Professionals, P.C. (Falcon Point Dental Care)
• Indian Creek Family Medicine,LLC
• Integrate Family Occupational Therapy (Integrate Family)
• Darrell Jackson
• Andrea Jensen
• Sharina E Jensen, CD(DONA), CLC
• Jesica Diaz
• Annie Johnson, PA-C
• Deserae Lei Johnson, LMT

• General Practice Dentistry in Kuna, ID
• Providers in Kuna, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.