Eagle Rock Dental Care
LBN: Eagle Rock Dental Care
Eagle Rock Dental Care is an health care organization with primary practice located at 640 S Woodruff Ave , Idaho Falls ID 83401-5299. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is the primary health care specialty.
Eagle Rock Dental Care can be contacted via phone (208) 523-5400, or through Chapple, Trudee L via phone (208) 523-5400.
Contact Information
Primary practice address
640 S Woodruff Ave
Idaho Falls ID 83401-5299
Phone: (208) 523-5400
Fax: (208) 528-0565
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | D-3271 | Idaho |
| Dental Providers / General Practice | 1223G0001X | D-1297 | Idaho |
| Dental Providers / General Practice | 1223G0001X | D-3063 | Idaho |
| Dental Providers / General Practice | 1223G0001X | D-1890 | Idaho |
| Dental Providers / General Practice | 1223G0001X | D4138 | Idaho |
Profile Details
| NPI number | 1356465660 |
|---|---|
| LBN Legal business name | Eagle Rock Dental Care |
| DBA Doing business as | |
| Authorized official | Chapple, Trudee L |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Mar 19th, 2007 |
| Last updated | Feb 3rd, 2014 - about 11 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1356465660 | NPPES |
| Idaho | Other | D4138 | ISDA |
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