Family Dental of Blackfoot LLC
NPI 1205208162ActiveOrganization· Dentist· Blackfoot, ID
Dentist in Blackfoot, Idaho, registered in NPPES in October 2015. The authorized official on file is Bryce Burtenshaw, Owner.
Overview
| NPI | 1205208162 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 30, 2015 |
| Last updated in NPPES | Oct 30, 2015 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | D-3614 | ID |
| Dentist | 122300000X | D-3830 | ID |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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