NPIMap

Organization Active NPI

Scott R Gardner DDS PC

  • Dentist
  • Nampa, ID
National Provider Identifier
1114187598
Registry record updated Jun 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D3527 Issued in ID
Legal business name
SCOTT R GARDNER DDS PC
Practice address
2065 12TH Ave Rd
Nampa, ID 83686-6311
Phone
(208) 466-3239
NPI assigned
Jun 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Scott Robert Gardner, DDSNPI 1104931526
Title
Detist
Phone
(208) 466-3239

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X D3527 ID Primary

Addresses

Primary practice location

2065 12TH Ave Rd
Nampa, ID 83686-6311

Mailing address

2065 12TH Ave Rd
Nampa, ID 83686-6311
Phone (208) 466-3239

Other identifiers 1

IdentifierTypeStateIssuer
806096200MedicaidID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1114187598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2065 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866311",
            "telephone_number": "208-466-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2065 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866311",
            "telephone_number": "208-466-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT R GARDNER DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "DETIST",
        "authorized_official_telephone_number": "208-466-3239",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806096200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.