Provider Demographics
NPI:1164101754
Name:COMMUNITY COUNCIL OF IDAHO INC
Entity Type:Organization
Organization Name:COMMUNITY COUNCIL OF IDAHO INC
Other - Org Name:CFC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-528-7655
Mailing Address - Street 1:2100 ALAN ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-528-7655
Mailing Address - Fax:
Practice Address - Street 1:3387 MERLIN DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-528-7655
Practice Address - Fax:208-524-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Multi-Specialty