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RUFUS O. VAN DYKE D.D.S. M.CL.D NPI 1487802096


NPI Information

NPI: 1487802096
Provider Name: RUFUS O. VAN DYKE, D.D.S., M.CL.D
Classification: Dentist - 1223X0400X
Entity Type: Organization

Specialization: Orthodontics and Dentofacial Orthopedics

Address:
1455 BENCH RD
SUITE A
POCATELLO, ID
ZIP 83201
Phone: (208) 237-3330
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RUFUS O. VAN DYKE, D.D.S., M.CL.D is an orthodontics and dentofacial orthopedics dentist in Pocatello, ID. The provider is that area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. RUFUS O. VAN DYKE, D.D.S., M.CL.D NPI is 1487802096. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1455 BENCH RD
SUITE A
POCATELLO, ID
ZIP 83201-083
Phone: (208) 237-3330

The provider's authorized official is Tracy Van Dyke .
The authorized official title is Office Manager and has the following contact phone number (208) 237-3330.

The enumeration date for this NPI number is 9/8/2008 and was last updated on 9/8/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223X0400XDentistOrthodontics and Dentofacial OrthopedicsD-3206-ORIDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
19211318MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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