FAMILY DENTAL OF BLACKFOOT LLC (NPI# 1205208162) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205208162 |
| Entity Type | Organization |
| Organization Name | FAMILY DENTAL OF BLACKFOOT LLC |
| Practice Address |
2407 Teeples Dr Blackfoot ID 83221-5877 |
| Practice Telephone | 2087820242 |
| Practice Fax Number | 2087821160 |
| Mailing Telephone | 2087820242 |
| Mailing Fax Number | 2087821160 |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2015-10-30 |
| Authorized Official Name | DR. BRYCE BURTENSHAW (OWNER) |
| Authorized Official Telephone | 2087820242 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | D-3830 | ID | Dental Providers |
| Y | 122300000X | Dentist | D-3614 | ID | Dental Providers |
| Street Address |
2407 TEEPLES DR |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221-5877 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407889470 | Peggy J Trebilcock | Dentist | 2407 Teeples Dr, Blackfoot, ID 83221-5877 | 2006-07-09 |
| 1477712966 | Peggy J Trebilcock Dds PC | Dentist | 2407 Teeples Dr, Blackfoot, ID 83221-5877 | 2008-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
| 1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
| 1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
| 1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
| 1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
| 1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
| 1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
| 1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
| 1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
| 1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
| Find all providers in zip 83221 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548887136 | Bald 1 Sleep Solutions LLC | Dentist | 790 N Meridian St, Blackfoot, ID 83221-4936 | 2020-06-29 |
| 1104038991 | Brent Wilson Harper | Dentist | 694 W. Hwy. 39, Blackfoot, ID 83221 | 2007-05-04 |
| 1194869990 | Charles Gordon Simpson | Dentist | 1180 Parkway Dr, Blackfoot, ID 83221-0869 | 2007-02-16 |
| 1821104910 | Von James Kunz | Dentist | 600 Jensen Grove Drive, Blackfoot, ID 83221 | 2006-08-22 |
| 1053321885 | Riverside Dental PC | Dentist | 1120 Parkway Dr, Blackfoot, ID 83221 | 2006-08-08 |
| 1700894771 | Richard Russell Burt | Dentist | 310 W Idaho St, Blackfoot, ID 83221-0248 | 2006-08-04 |
| 1578958252 | Blackfoot Family Dentistry Pllc | Dentist | 380 W Judicial St, Blackfoot, ID 83221-2122 | 2015-03-31 |
| 1578884235 | Kelly Weaver | Dentist | 310 W Idaho St, Blackfoot, ID 83221-1710 | 2010-06-17 |
| 1831415447 | Paul Lloyd Hansen | Dentist | 625 W Bridge St, Blackfoot, ID 83221-2018 | 2010-04-08 |
| 1588837496 | Damon T. Armstrong D.d.s., P.c | Dentist | 625 W Pacific St, Suite #4, Blackfoot, ID 83221-2034 | 2008-04-11 |
| Find all providers in BLACKFOOT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.