THE FAMILY DENTAL CENTER, PLLC (NPI# 1538186366) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538186366 |
| Entity Type | Organization |
| Organization Name | THE FAMILY DENTAL CENTER, PLLC |
| Practice Address |
625 W Bridge St Blackfoot ID 83221-2018 |
| Mailing Address |
Po Box 458 Blackfoot ID 83221-0458 |
| Practice Telephone | 2087852685 |
| Practice Fax Number | 2087850998 |
| Mailing Telephone | 2087852685 |
| Mailing Fax Number | 2087850998 |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. KAREN J. PRUETT (OFFICE MANAGER) |
| Authorized Official Telephone | 2087852685 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D3613 | ID | Dental Providers |
| Street Address |
625 W BRIDGE ST |
| City | BLACKFOOT |
| State | ID |
| Zip Code | 83221-2018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831415447 | Paul Lloyd Hansen | Dentist | 625 W Bridge St, Blackfoot, ID 83221-2018 | 2010-04-08 |
| 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 | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164583761 | Damon Taylor Armstrong | Dentist | 625 W Pacific St Ste 4, Blackfoot, ID 83221-2034 | 2006-12-13 |
| 1730240102 | Troy Gordon Simpson | Dentist | 1180 Parkway Drive, Blackfoot, ID 83221-0869 | 2006-12-12 |
| 1063522183 | Dennis Scott Hatch | Dentist | 1177 Parkway Dr, Blackfoot, ID 83221-1652 | 2006-08-30 |
| 1407889470 | Peggy J Trebilcock | Dentist | 2407 Teeples Dr, Blackfoot, ID 83221-5877 | 2006-07-09 |
| 1245560945 | Affordable Family Dentistry PC | Dentist | 1120 Parkway Dr, Blackfoot, ID 83221-1651 | 2010-01-04 |
| 1659507481 | Tracy Dean Jenkins | Dentist | 1120 Parkway Dr, Blackfoot, ID 83221-1651 | 2009-06-08 |
| 1477712966 | Peggy J Trebilcock Dds PC | Dentist | 2407 Teeples Dr, Blackfoot, ID 83221-5877 | 2008-06-09 |
| 1225208655 | Bradford William Harper | Dentist | 1120 Parkway Dr, Blackfoot, ID 83221-1651 | 2008-02-29 |
| 1952436883 | Simpson Dental Offices | Dentist | 1180 Parkway Dr, Blackfoot, ID 83221-1651 | 2007-02-22 |
| 1154485373 | Wilson Richard Armstrong | Dentist | 625 W Pacific St Ste 4, Blackfoot, ID 83221-2034 | 2006-12-21 |
| 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.