Individual provider Active NPI

Paul J Clawson, DDS

  • General Practice Dentistry
  • Nampa, ID
National Provider Identifier
1518371251
Registry record updated Jun 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-4575 Issued in ID
Practice address
1601 12TH Ave Rd
Ste 103
Nampa, ID 83686-7711
Phone
(208) 467-9690
Fax
(208) 466-0412
NPI assigned
Jun 19, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D-4575 ID Primary

Addresses

Primary practice location

1601 12TH Ave Rd
Ste 103
Nampa, ID 83686-7711

Mailing address

1601 12TH Ave Rd
Ste 103
Nampa, ID 83686-7711
Phone (208) 467-9690

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20161205001790 ID Order and Referring Only - DentistPractitioner - Dentist 6507146792

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D-4575IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Gentle Dental Care PLLC General Practice 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": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403136000000",
    "number": "1518371251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 12TH AVE RD",
            "address_2": "STE 103",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836867711",
            "telephone_number": "208-467-9690",
            "fax_number": "208-466-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 12TH AVE RD",
            "address_2": "STE 103",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836867711",
            "telephone_number": "208-467-9690",
            "fax_number": "208-466-0412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLAWSON",
        "first_name": "PAUL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-19",
        "last_updated": "2014-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-4575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.