Bryce D Hanson, DMD PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D-3275 Issued in ID

Legal business name

BRYCE D HANSON, DMD PA

Doing business as

River Valley Dental Care

Practice address

371 W Fir St
Shelley, ID 83274-1456

Phone

(208) 357-7611

Fax

(208) 357-1805

NPI assigned

Dec 3, 2014

Last updated

Dec 3, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bryce D Hanson, DMDNPI 1629027099

Title

Owner

Phone

(208) 357-7611

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• River Valley Dental Care Doing business as

Locations

Practitioners 2

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.

• Bryce D Hanson, D.M.D

  • Dentist
  • Shelley, ID
  • NPI 1629027099
  NPD (past) Authorized official
• Steven F Nielsen, D.D.S.

  • Dentist
  • Shelley, ID
  • NPI 1528018967
  NPD (past)

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1851798045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 525",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832740525",
            "telephone_number": "208-357-7611",
            "fax_number": "208-357-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "371 W FIR ST",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832741456",
            "telephone_number": "208-357-7611",
            "fax_number": "208-357-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYCE D HANSON, DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "BRYCE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-357-7611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D-3275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119-477-4109",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0025-57200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8050-31700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Valley Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• BMH Inc (Physicians and Surgeons of Shelley)
• Nathan Bolander
• Samantha Ryleigh Brandt, DPT, PT
• Broulim Supermarkets, LLC (Broulim's Pharmacy #9 - Shelley)
• Chrystal Dawn Browning, PT, DPT, PCS
• Maria Magdalena Camacho, LCSW
• Alexis Carlson
• Curtis W Carpenter, D.D.S.
• Kristee K. Criddle, LISW
• Cruz Therapy Services (Shelley Physical Therapy & Fitness Center)

• Dental Clinic/Center in Shelley, ID
• Providers in Shelley, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; 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.