Shannon Widmier, D.D. S. P.A.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3342 Issued in ID

Practice address

702 Center Street West
Kimberly, ID 83341

Phone

(208) 423-6444

Fax

(208) 423-6903

NPI assigned

Sep 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kent J Allen/ Shannon Widmier

  dba Pheasant Cove Dental

  • General Practice Dentistry
  • Kimberly, ID
  • NPI 1770769325
  NPD (past)
• Weston Frandsen LLC

  • General Practice Dentistry
  • Kimberly, ID
  • NPI 1770493827
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396842779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX B",
            "city": "KIMBERLY",
            "state": "ID",
            "postal_code": "833410010",
            "telephone_number": "208-423-6444",
            "fax_number": "208-423-6903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 CENTER STREET WEST",
            "city": "KIMBERLY",
            "state": "ID",
            "postal_code": "83341",
            "telephone_number": "208-423-6444",
            "fax_number": "208-423-6903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDMIER",
        "first_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "D.D. S. P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trevor Baker Physical Therapy (Baker Mobile Therapy)
• Laura Ann Vriesman, IS
• Reagan Ronald Ward, DPT
• Weston Frandsen LLC
• Kara Marie Wheeler, FNP
• Ashlyn Marie Zoon, DPT

• General Practice Dentistry in Kimberly, ID
• Providers in Kimberly, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.