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Contact Information

FOOTHILLS DENTAL CARE, PLLC
1655 PANCHERI DR
IDAHO FALLS, ID83402-3169
 Phone: 208-522-1911
 Fax: 208-523-4441
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for FOOTHILLS DENTAL CARE, PLLC

NPI Number 1205175668
LBN Legal business name FOOTHILLS DENTAL CARE, PLLC
Authorized official MELISSA RAICHART - (INSURANCE COORDINATOR)
Entity Organization
Organization subpart 1 Yes
Enumeration date 02/05/2013
Last updated 02/06/2013 - About 13 years ago
Identifiers
ID License # D1719
ID License # D3464
ID License # D3971
ID License # D4302
ID Medicaid 1124035498
ID Medicaid 1134356140
ID Medicaid 1275619090
ID Medicaid 1609952415
ID Medicaid 1740501410
ID Medicaid 1952317703
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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