Fairview Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FAIRVIEW DENTAL PLLC

Practice address

329 E Logan St
Caldwell, ID 83605-4863

Phone

(208) 459-3388

NPI assigned

Jun 21, 2023

Organization subpart

No

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

Authorized official

Name

Sean Wasden

Title

Coo

Phone

(208) 965-9415

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1687305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1992480404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 3RD ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513840",
            "telephone_number": "208-965-9415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 E LOGAN ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054863",
            "telephone_number": "208-459-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-21",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "WASDEN",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "208-965-9415"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; 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.