Northwest Endodontics PC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D1930EN Issued in ID

Legal business name

NORTHWEST ENDODONTICS PC

Practice address

509 W Hanley
Ste 202
Coeur D Alene, ID 83815

Phone

(208) 667-8622

Fax

(208) 664-2402

NPI assigned

Jan 2, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Timothy Walther Penberthy, DRNPI 1285786194

Title

Owner

Phone

(208) 667-8622

Specialties & licenses 1

Addresses

Other names 1

• Timothy W Penberthy DDS Former legal business name

Locations

Practitioners 3

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

• Timothy Walter Penberthy, D.D.S.

  • Endodontics
  • Coeur D Alene, ID
  • NPI 1285786194
  NPD (past) Authorized official
• Brittney Ann Penberthy, D.D.S

  • Endodontics
  • Coeur D Alene, ID
  • NPI 1780023275
  NPD (past)
• Skylar Penberthy, DMD

  • Dentist
  • Boston, MA
  • NPI 1225676919
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1972660769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 W HANLEY",
            "address_2": "STE 202",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "83815",
            "telephone_number": "208-667-8622",
            "fax_number": "208-664-2402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 W HANLEY",
            "address_2": "STE 202",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "83815",
            "telephone_number": "208-667-8622",
            "fax_number": "208-664-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ENDODONTICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "PENBERTHY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "WALTHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-667-8622",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DR"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "ID",
            "license": "D1930EN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Timothy W Penberthy DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Northwest Psychiatric Associates PA
• Aaron J Notestine, M.D.
• Ashely Wells Notestine, LCPC 7410

• Endodontics in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Endodontics in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.