NPIMap

Organization Active NPI

Excellence in Dentistry PA

  • General Practice Dentistry
  • Idaho Falls, ID
National Provider Identifier
1881602266
Registry record updated Dec 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D1637 Issued in ID
Legal business name
EXCELLENCE IN DENTISTRY PA
Practice address
2515 Channing Way
Idaho Falls, ID 83404-7516
Phone
(208) 529-4321
Fax
(208) 529-8609
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2010

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

Authorized official

Name
Dr. Duane Kent Godfrey, DDSNPI 1538135371
Title
Dentist
Phone
(208) 529-4321

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D1637 ID Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D3983 ID

Addresses

Primary practice location

2515 Channing Way
Idaho Falls, ID 83404-7516

Mailing address

2515 Channing Way
Idaho Falls, ID 83404-7516
Phone (208) 529-4321

Other identifiers 2

IdentifierTypeStateIssuer
807539000MedicaidID
000755500MedicaidID

National Provider Directory

National Provider Directory

Locations

2515 Channing Way
Idaho Falls, ID 83404
Phone (208) 529-4321

Practitioners & affiliated clinicians

Practitioners 2

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": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292544000000",
    "number": "1881602266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047516",
            "telephone_number": "208-529-4321",
            "fax_number": "208-529-8609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047516",
            "telephone_number": "208-529-4321",
            "fax_number": "208-529-8609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELLENCE IN DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2010-12-17",
        "status": "A",
        "authorized_official_last_name": "GODFREY",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-529-4321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1637",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3983",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807539000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000755500",
            "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 Dec 17, 2010; 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.