Burtenshaw Craig A & G Staley Gps
LBN: Famliy Dental Health Center
Burtenshaw Craig A & G Staley Gps is an health care organization with primary practice located at 200 N Woodruff Ave , Idaho Falls ID 83401-4334. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty.
Famliy Dental Health Center can be contacted via phone (208) 529-0120, or through Staley, Galen Jay via phone (208) 529-0120.
Contact Information
Primary practice address
200 N Woodruff Ave
Idaho Falls ID 83401-4334
Phone: (208) 529-0120
Fax:
Website:
Authorized official contact:
Name: Staley, Galen Jay Doctor of Dental Surgery (DDS)
Phone: (208) 529-0120
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | D1628 | Idaho |
| Dental Providers / Dentist | 122300000X | D3064 | Idaho |
| Dental Providers / Dentist | 122300000X | D3614 | Idaho |
| Dental Providers / Dentist | 122300000X | D3038 | Idaho |
Profile Details
| NPI number | 1679745269 |
|---|---|
| LBN Legal business name | Famliy Dental Health Center |
| DBA Doing business as | Burtenshaw Craig A & G Staley Gps |
| Authorized official | Staley, Galen Jay Doctor of Dental Surgery (DDS) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Mar 24th, 2008 |
| Last updated | Jun 19th, 2008 - about 16 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 | 1679745269 | NPPES |
| Idaho | MEDICAID | 806335900 | |
| Idaho | MEDICAID | 806939100 | |
| Idaho | MEDICAID | 02740700 | |
| Idaho | MEDICAID | 00274600 |
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