Kaitlin Rebecca Gagnon, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D-5514 Issued in ID

Practice address

810 Sixth Ave
Sandpoint, ID 83864-5396

Phone

(208) 265-2242

NPI assigned

May 30, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Boundary Regional Community Health Center Inc

  dba Kaniksu Community Health

  • Federally Qualified Health Center (FQHC)
  • Bonners Ferry, ID
  • NPI 1306883244
  NPD (past)
• Boundary Regional Community Health Center, Inc.

  dba Kaniksu Community Health

  • Federally Qualified Health Center (FQHC)
  • Sandpoint, ID
  • NPI 1316343320
  NPD (past)

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

{
    "created_epoch": "1685404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770163200000",
    "number": "1467145169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 SIXTH AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645396",
            "telephone_number": "208-946-7187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 SIXTH AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645396",
            "telephone_number": "208-265-2242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6615 Comanche St",
            "address_purpose": "LOCATION",
            "city": "Bonners Ferry",
            "state": "ID",
            "postal_code": "838057523",
            "country_code": "US",
            "telephone_number": "208-267-1718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "KAITLIN",
        "middle_name": "REBECCA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-30",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "ID",
            "license": "D-5514",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-5514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Ann Gabica-Grand, LMSW
• Audra Lou Gabica
• Maia Cassandra Gaddess, LMT
• Jeremiah Gagnon, OD
• Julie Beth Gagnon, OD
• Gina Marie Garvin, LMT
• Joline Elizabeth Genay-Wolf, LMT
• Megan Gentry, PA-C
• Charles C George, MD
• Cyndi Marie Gerstenberger, APRN PMHNP-BC

• Dentist in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; 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.