Patrick L Waite, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3975 Issued in ID

Practice address

4101 Clock Tower Ave
Caldwell, ID 83607

Phone

(208) 455-0022

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

State licenses

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513814400000",
    "number": "1407998271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 CLOCK TOWER AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "83607",
            "telephone_number": "208-455-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 CLOCK TOWER AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "83607",
            "telephone_number": "208-455-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAITE",
        "first_name": "PATRICK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2017-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807500200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Caldwell, ID
• Providers in Caldwell, 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 Dec 21, 2017; 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.