Oak Mountain Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

D-4484 Issued in ID

Legal business name

OAK MOUNTAIN DENTAL PLLC

Practice address

135 Warren Ave
Pocatello, ID 83201-4621

Phone

(208) 237-6453

Fax

(208) 233-4227

NPI assigned

May 9, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Jake R Richards, DDS

Title

Dentist

Phone

(208) 237-6453

Specialties & licenses 1

Addresses

Other names 1

• JAKE R RICHARDS DDS, PLLC Former legal business name

Locations

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

{
    "created_epoch": "1368057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1861837478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 WARREN AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014621",
            "telephone_number": "208-237-6453",
            "fax_number": "208-233-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 WARREN AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014621",
            "telephone_number": "208-237-6453",
            "fax_number": "208-233-4227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK MOUNTAIN DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-09",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "JAKE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-237-6453",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JAKE R RICHARDS DDS, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Alexandra O'Callaghan
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• Elizabeth Anne O'Neil, AUD
• Saeward O'Neill, LPC
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• Jordan Ohmie, DPT

• Dentist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; 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.