Individual provider Active NPI

Gregory Scott Guymon, DDS, MS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Meridian, ID
National Provider Identifier
1417060302
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
D3295OR Issued in ID
Practice address
1200 W Cherry LN Ste 101
Meridian, ID 83642-4933
Phone
(208) 898-0000
Fax
(208) 898-9000
NPI assigned
Aug 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X D3295OR ID Primary

Addresses

Primary practice location

1200 W Cherry LN Ste 101
Meridian, ID 83642-4933

Mailing address

1200 W Cherry LN Ste 101
Meridian, ID 83642-4933
Phone (208) 898-0000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
D3295ORIDMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Treasure Valley Orthodontics Orthodontics and Dentofacial Orthopedics Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417060302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W CHERRY LN STE 101",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424933",
            "telephone_number": "208-898-0000",
            "fax_number": "208-898-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W CHERRY LN STE 101",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424933",
            "telephone_number": "208-898-0000",
            "fax_number": "208-898-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUYMON",
        "first_name": "GREGORY",
        "middle_name": "SCOTT",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "D3295OR",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.