NPIMap

Organization Active NPI

Townsquare Dental of Blackfoot PLLC

  • General Practice Dentistry
  • Blackfoot, ID
National Provider Identifier
1861260093
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TOWNSQUARE DENTAL OF BLACKFOOT PLLC
Doing business as
Townsquare Dental of Blackfoot
Practice address
1120 Parkway Dr
Blackfoot, ID 83221-1651
Phone
(208) 785-0878
NPI assigned
Dec 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Authorized official

Name
Boone Allen, DDSNPI 1396857256
Title
Owner
Phone
(208) 785-0878

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1120 Parkway Dr
Blackfoot, ID 83221-1651

Mailing address

1120 Parkway Dr
Blackfoot, ID 83221-1651
Phone (208) 785-0878

Other practice location 1

527 Rigby Lake Dr Ste B
Rigby, ID 83442-5117
Phone (208) 745-8704

Other names 1

  • Townsquare Dental of Blackfoot Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1861260093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 PARKWAY DR",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211651",
            "telephone_number": "208-785-0878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 PARKWAY DR",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211651",
            "telephone_number": "208-785-0878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "527 Rigby Lake Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Rigby",
            "state": "ID",
            "postal_code": "834425117",
            "country_code": "US",
            "telephone_number": "208-745-8704",
            "fax_number": "208-745-7052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TOWNSQUARE DENTAL OF BLACKFOOT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-18",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "BOONE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-785-0878",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Townsquare Dental of Blackfoot",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackfoot, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; 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.