NPIMap

Organization Active NPI

Seasons Dental

  • General Practice Dentistry
  • Burley, ID
National Provider Identifier
1982157962
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4151 Issued in ID
Legal business name
SEASONS DENTAL
Practice address
425 N Overland Ave
Burley, ID 83318-3434
Phone
(208) 679-1679
NPI assigned
Jul 26, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2016

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

Authorized official

Name
Dr. Travis T Bodily, D.M.D.NPI 1518128933
Title
Owner
Phone
(208) 679-1679

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: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 4151 ID Primary

Addresses

Primary practice location

425 N Overland Ave
Burley, ID 83318-3434

Mailing address

425 N Overland Ave
Burley, ID 83318-3434
Phone (208) 679-1679

National Provider Directory

National Provider Directory

Locations

425 N Overland Ave
Burley, ID 83318
Phone (208) 430-9555

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": "1469491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1982157962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N OVERLAND AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833183434",
            "telephone_number": "208-679-1679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 N OVERLAND AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833183434",
            "telephone_number": "208-679-1679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASONS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-26",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "BODILY",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-679-1679",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "4151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burley, ID

Sources for this page

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