John R Garrard, D.D.S.
Individual provider Active NPI General Practice Dentistry · Rupert, ID
NPI 1124056544 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124056544
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D-3400 (ID)
- Practice address
- 301 Scott Ave
Rupert, ID 83350-1800 - Phone
- (208) 436-6406
- Fax
- (208) 436-9678
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160426001822 | ID | Order and Referring Only - Dentist |
4284933227 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-3400 | ID | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Doctors Garrard and Wayment Dentists PLLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D-3400 | ID | Yes |
Addresses
Primary practice location
301 Scott Ave
Rupert, ID 83350-1800
Mailing address
PO Box 338
Rupert, ID 83350-0338
Phone (208) 436-6406
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010135366 | Other | REGENCE BLUE SHIELD | |
| 1444442 | Other | UNITED CONCORDIA | |
| 3400 | Other | ID | DELTA DENTAL |
| 6F688 | Other | ID | BLUE CROSS |
Other providers in Rupert, ID
- Family Health Services Corporation
- Family Vision and Eye Care PA
- Bonita Jo Anne Frazier-Shewmaker
- Jessica Shirley Gaby
- Kai Samuel Garner
- Peggy Goodman
- Benjamin Guercio
- Heather Harper
- Terra J Haynes
- Maria E. Hernandez
All providers in Rupert, ID · General Practice Dentistry in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.