NPIMap

Organization Active NPI

Summit Dental Care Group, PLLC

  • Dentist
  • Twin Falls, ID
National Provider Identifier
1871753608
Registry record updated Feb 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D3892 Issued in ID
Legal business name
SUMMIT DENTAL CARE GROUP, PLLC
Practice address
285 Canyon Crest Dr
Twin Falls, ID 83301-5359
Phone
(208) 733-9999
Fax
(208) 733-9699
NPI assigned
Jun 16, 2008
Last updated
Feb 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2014

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

Authorized official

Name
Alisa Frame, FAADOM
Title
Practice Administrator
Phone
(208) 733-9999

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D4455 ID
Dentist 122300000X D3892 ID Primary
General Practice Dentistry 1223G0001X

Addresses

Primary practice location

285 Canyon Crest Dr
Twin Falls, ID 83301-5359

Mailing address

285 Canyon Crest Drive
Twin Falls, ID 83301
Phone (208) 733-9999

Other identifiers 1

IdentifierTypeStateIssuer
807190600MedicaidID

National Provider Directory

National Provider Directory

Locations

285 Canyon Crest Dr
Twin Falls, ID 83301
Phone (208) 733-9999

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1213574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391644800000",
    "number": "1871753608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 CANYON CREST DRIVE",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "83301",
            "telephone_number": "208-733-9999",
            "fax_number": "208-733-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 CANYON CREST DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015359",
            "telephone_number": "208-733-9999",
            "fax_number": "208-733-9699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT DENTAL CARE GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-16",
        "last_updated": "2014-02-06",
        "status": "A",
        "authorized_official_last_name": "FRAME",
        "authorized_official_first_name": "ALISA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "208-733-9999",
        "authorized_official_credential": "FAADOM"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D4455",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3892",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807190600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.