# EAGLE ROCK DENTAL CARE PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EAGLE ROCK DENTAL CARE PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1326395385
- **Legal business name:** EAGLE ROCK DENTAL CARE PLLC
- **Authorized official:** TRUDEE L CHAPPLE (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (208) 523-5400

## Contact information

- **Practice address:** 2205 CHANNING WAY STE B, IDAHO FALLS, ID 83404-8016
- **Practice address phone:** (208) 529-3660
- **Practice address fax:** (208) 529-3666
- **Mailing address:** 2205 CHANNING WAY STE B, IDAHO FALLS, ID 83404-8016
- **Mailing address phone:** (208) 529-3660
- **Mailing address fax:** (208) 529-3666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1608 | ID | — |
| 1223G0001X | General Practice Dentistry | D1890 | ID | — |
| 1223G0001X | General Practice Dentistry | D3063 | ID | Yes |
| 1223G0001X | General Practice Dentistry | D4036 | ID | — |
| 1223G0001X | General Practice Dentistry | D4138 | ID | — |
| 1223G0001X | General Practice Dentistry | D4369 | ID | — |

## Other

- **Enumeration date:** 08/09/2012
- **Last updated:** 08/24/2012