All Phases Dentistry PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4200 Issued in ID

Legal business name

ALL PHASES DENTISTRY PLLC

Practice address

3810 N Garden Center Way
Boise, ID 83703-5007

Phone

(208) 853-5111

Fax

(208) 853-5112

NPI assigned

May 21, 2014

Organization subpart

No

Name

Mrs. Anissa Ferguson

Title

Business Manager

Phone

(208) 695-5913

• Craig C Sjoberg Sole Member Other name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 21, 2014.

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400630400000",
    "number": "1992117287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3810 N GARDEN CENTER WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035007",
            "telephone_number": "208-853-5111",
            "fax_number": "208-853-5112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 N GARDEN CENTER WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035007",
            "telephone_number": "208-853-5111",
            "fax_number": "208-853-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALL PHASES DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-21",
        "last_updated": "2014-05-21",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "ANISSA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "208-695-5913",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Craig C Sjoberg Sole Member",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2014; 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.