Brent Charles Goldthorpe, D.M.D.
Individual provider Active NPI General Practice Dentistry · Mountain Home, ID
NPI 1992960116 · NPPES record last updated Mar 18, 2024
Key facts
- NPI
- 1992960116
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D4080 (ID)
- Practice address
- 120 Desert Sage Way
Mountain Home, ID 83647-1038 - Phone
- (208) 696-7203
- Fax
- (208) 587-3324
- NPI assigned
- Jul 28, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171020002114 | ID | Order and Referring Only - Dentist |
2961778899 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D4080 | ID | MD | General Practice Dentistry |
| 2358 | MT | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit View Dental Services PLLC | Past | Accepting new patients | |
| Glenns Ferry Health Center, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2358 | MT | |
| General Practice Dentistry | 1223G0001X | D4080 | ID | Yes |
Addresses
Primary practice location
120 Desert Sage Way
Mountain Home, ID 83647-1038
Mailing address
120 Desert Sage Way
Mountain Home, ID 83647-1038
Phone (208) 587-3988
Other providers in Mountain Home, ID
- Colleen M Gingerich
- Glenns Ferry Health Center, Inc.
- Glenns Ferry Health Center, Inc.
- Glenns Ferry Health Center, Inc.
- Amy Jo Glover
- John Earl Goodrich
- Lisa Jo Goodsell
- Terri Lynn Grasham
- Katherine Gray
- Paige Gray
All providers in Mountain Home, ID · General Practice Dentistry in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.