Stanton D Widmer, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

#D-4148 Issued in ID

Practice address

4207 Clocktower Ave.
Caldwell, ID 83607-5236

Phone

(208) 454-3636

Fax

(208) 454-1333

NPI assigned

Jul 7, 2008

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 12, 2025 through Feb 12, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Treasure Valley Endodontics, P.C.

  • Endodontics
  • Caldwell, ID
  • NPI 1770307084
  NPD Authorized official

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215388800000",
    "number": "1497918809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4207 CLOCKTOWER AVE.",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836075236",
            "telephone_number": "208-454-3636",
            "fax_number": "208-454-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4207 CLOCKTOWER AVE.",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836075236",
            "telephone_number": "208-454-3636",
            "fax_number": "208-454-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDMER",
        "first_name": "STANTON",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-07",
        "last_updated": "2008-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "ID",
            "license": "#D-4148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gillian Wheadon
• White Willow Massage
• Ashley Fae White, NP
• Kayla White, LPC
• Savannah M Whiting, DO
• Bryce Wikfors, PA-C
• Michael E Wiley, LCSW
• Williams and Uralde Inc.
• Angela Marie Williams
• Delanie W Williamson, MED

• Endodontics in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Endodontics in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.