Tom Gudmestad, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3117 Issued in ID

Practice address

522 E 4TH St
Weiser, ID 83672-2205

Phone

(208) 549-2213

Fax

(208) 549-4187

NPI assigned

Aug 1, 2006

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

Other identifiers 2

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

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686873600000",
    "number": "1851308050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 E 4TH ST",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836722205",
            "telephone_number": "208-549-2213",
            "fax_number": "208-549-4187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 E 4TH ST",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836722205",
            "telephone_number": "208-549-2213",
            "fax_number": "208-549-4187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDMESTAD",
        "first_name": "TOM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID PAYEE NUMBE",
            "identifier": "61937",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000504200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Marie Gallegos, LCSW
• Anika Garcia
• Alicia Gonzalez
• Michelle Lynn Grendahl, LPC
• Janice Elaine Grimaldo, SLP
• Kent Leroy Hamilton, PAC
• Melissa A Hathhorn, NP
• Laura Haun, A.T.C.
• Duane Ray Hess, DC
• Craig Philip Hessing, DPT

• General Practice Dentistry in Weiser, ID
• Providers in Weiser, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; 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.