Gaylan Chris Holdaway, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D-4798 Issued in ID

Practice address

3325 N Ten Mile Rd # 140
Meridian, ID 83646-5409

Phone

(208) 228-5499

Fax

(855) 204-6128

NPI assigned

May 26, 2009

Sex

Male

Sole proprietor

Yes

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 NC

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

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.

• Birchwood Dental, PLLC

  • General Practice Dentistry
  • Meridian, ID
  • NPI 1891304556
  NPD Authorized official

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1528293255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 N TEN MILE RD STE 140",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466951",
            "telephone_number": "336-509-0278",
            "fax_number": "855-204-6128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 N TEN MILE RD # 140",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836465409",
            "telephone_number": "208-228-5499",
            "fax_number": "855-204-6128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDAWAY",
        "first_name": "GAYLAN",
        "middle_name": "CHRIS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-26",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "8766",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bennett Briard Hofmeister
• Mark Alan Hofstetter, PHARM.D.
• John A Hogg, O.D.
• Ryan Stuart Hogue
• Kristen Amber Holcomb, MS, CCC-SLP
• Britney Dawn Holden, CPNP-PC
• J Holden, PHARMD
• Katy Holder, PA-C
• Katherine Hole, LMSW
• Danica Holladay, LPC

• All providers in Meridian, ID
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; 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.