=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336038355
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARL CALL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2025
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 S 300 E
-----------------------------------------------------
City | MALAD CITY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83252-1343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-766-2204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 290 E 100 S
-----------------------------------------------------
City | WILLARD
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84340-9739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-720-0832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6671966
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------