Russell Guymon Orthodontics, PA

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D-4402-OR Issued in ID

Legal business name

RUSSELL GUYMON ORTHODONTICS, PA

Practice address

333 S Woodruff Ave
Idaho Falls, ID 83401-4322

Phone

(208) 529-3500

NPI assigned

Feb 1, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Russell J Guymon, DDS, MS

Title

Owner/Orthodontist

Phone

(208) 529-3500

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1194097402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014322",
            "telephone_number": "208-529-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014322",
            "telephone_number": "208-529-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL GUYMON ORTHODONTICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "GUYMON",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/ORTHODONTIST",
        "authorized_official_telephone_number": "208-529-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "D-4402-OR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10584378285",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Grace Ruffner
• Kevin Ruhnau
• Anna Ruiz-Gruwell, NP-C
• Brooke Sue Rupe, COTA/L
• Michael Rupp
• Daric J Russell, DO
• Sarah Lynn Russell, BSW, LMSW
• Lisa J Russom, LSW
• Orin Kelley Ryan, DPT
• Rhonda Ryan, L.M.T.

• Orthodontics and Dentofacial Orthopedics Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; 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.