Avalon Dental PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D3875 Issued in ID

Legal business name

AVALON DENTAL PC

Practice address

672 E Wythe Creek CT
Ste 101
Kuna, ID 83634-5216

Phone

(208) 629-2800

Fax

(208) 629-2801

NPI assigned

May 31, 2016

Organization subpart

No

Name

Dr. James D. Grant, DMD

Title

Owner

Phone

(208) 629-2800

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

• Michael Jangula

  • General Practice Dentistry
  • Kuna, ID
  • NPI 1821407552
  NPD (past)
• Brigham Derk Murray, CRNA

  • Certified Registered Nurse Anesthetist
  • Nampa, ID
  • NPI 1619234655
  NPD (past)
• Jason Keith Olson, DMD

  • General Practice Dentistry
  • Kuna, ID
  • NPI 1558054163
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 31, 2016.

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464652800000",
    "number": "1962850933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "672 E WYTHE CREEK CT",
            "address_2": "STE 101",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836345216",
            "telephone_number": "208-629-2800",
            "fax_number": "208-629-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "672 E WYTHE CREEK CT",
            "address_2": "STE 101",
            "city": "KUNA",
            "state": "ID",
            "postal_code": "836345216",
            "telephone_number": "208-629-2800",
            "fax_number": "208-629-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2016-05-31",
        "status": "A",
        "authorized_official_last_name": "GRANT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-629-2800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D3875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PROVIDER",
            "identifier": "1447345491",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alliance Medical Group, LLC
• Ronald W Alm, DPM
• Jessica Anderson, MS, CCC-SLP
• Yasser Aref
• Megan Aumeier, PA-C
• Jeffrey V Ball, PA
• Stacey Balla
• Dolly Anne Barnes, LCSW
• Shawn Barrow
• Alexandra E Beattie, MD

• All providers in Kuna, ID
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; 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.