NPIMap

Organization Active NPI

Parkwest Dental Care

  • Dental Clinic/Center
  • Idaho Falls, ID
National Provider Identifier
1861666745
Registry record updated Aug 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D-3203 Issued in ID
Legal business name
PARKWEST DENTAL CARE
Practice address
1088 N Skyline Dr
Idaho Falls, ID 83402-1726
Phone
(208) 524-0870
Fax
(208) 524-0873
NPI assigned
Apr 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2020

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

Authorized official

Name
Brett D. Jacobson, DDSNPI 1811057623
Title
Owner/Dentist
Phone
(208) 524-0870

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
Dental Clinic/Center 261QD0000X D-3203 ID Primary

Addresses

Primary practice location

1088 N Skyline Dr
Idaho Falls, ID 83402-1726

Mailing address

885 Pancheri Dr
Idaho Falls, ID 83402-3344
Phone (208) 524-0870

Other identifiers 1

IdentifierTypeStateIssuer
003552200MedicaidID

National Provider Directory

National Provider Directory

Locations

1088 N Skyline Dr
Idaho Falls, ID 83402
Phone (208) 524-0870

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": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596758400000",
    "number": "1861666745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 PANCHERI DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023344",
            "telephone_number": "208-524-0870",
            "fax_number": "208-524-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1088 N SKYLINE DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834021726",
            "telephone_number": "208-524-0870",
            "fax_number": "208-524-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKWEST DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "208-524-0870",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D-3203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003552200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; 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.