Times Square Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3254 Issued in ID

Legal business name

TIMES SQUARE DENTAL

Practice address

1529 S Times Square CRT
Boise, ID 83709

Phone

(208) 343-1981

NPI assigned

Jun 5, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jon R Hastings, DDSNPI 1457369746

Title

Dentist

Phone

(208) 343-1981

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Jon Riley Hastings, DDS

  • General Practice Dentistry
  • Boise, ID
  • NPI 1457369746
  NPD (past) Authorized official

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1942469713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1529 S TIMES SQUARE CRT",
            "address_2": "STE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83709",
            "telephone_number": "208-343-1981",
            "fax_number": "208-672-9067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1529 S TIMES SQUARE CRT",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83709",
            "telephone_number": "208-343-1981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMES SQUARE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "HASTINGS",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "208-343-1981",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804158500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelli Tillquist, PSYD
• Daniel Edward Timberlake, PHD
• Timberline Medical Consultants LLC
• Timberline Sports Massage LLC
• Times Square Dental
• Nicole Timme, RD
• Kevin Timmel, MD
• Timothy C. Paventy DMD, LLC
• Timothy Floyd, MD, PLLC
• Timothy J Johans, MD

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; 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.