NPIMap

Organization Active NPI

Douglas J. Smith

  • General Practice Dentistry
  • Rexburg, ID
National Provider Identifier
1962664458
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D1433 Issued in ID
Legal business name
DOUGLAS J. SMITH
Practice address
56 Professional PLZ
Rexburg, ID 83440-2047
Phone
(208) 356-9262
Fax
(208) 356-4804
NPI assigned
Jun 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

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

Authorized official

Name
Douglas J Smith, DDSNPI 1316078397
Title
Owner-Dentist
Phone
(208) 356-9262

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D1433 ID Primary

Addresses

Primary practice location

56 Professional PLZ
Rexburg, ID 83440-2047

Mailing address

56 Professional PLZ
Rexburg, ID 83440-2047
Phone (208) 356-9262

Other identifiers 1

IdentifierTypeStateIssuer
001193200MedicaidID

Other names 1

  • Dental Health Center Doing business as

National Provider Directory

National Provider Directory

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": "1214438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1962664458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 PROFESSIONAL PLZ",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402047",
            "telephone_number": "208-356-9262",
            "fax_number": "208-356-4804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 PROFESSIONAL PLZ",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402047",
            "telephone_number": "208-356-9262",
            "fax_number": "208-356-4804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS J. SMITH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-26",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER-DENTIST",
        "authorized_official_telephone_number": "208-356-9262",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001193200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rexburg, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.