Active NPI
Wayne Julian Spector, D.M.D.
- General Practice Dentistry
- Ketchum, ID
National Provider Identifier
1861600330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D-1762
- Practice address
- 680 2ND Ave. North
Ketchum, ID 83340 - Phone
- (208) 726-7559
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D-1762 | ID | Primary |
Addresses
Primary practice location
680 2ND Ave. North
Ketchum, ID 83340
Mailing address
PO Box 4591
Ketchum, ID 83340-4591
Phone (208) 726-7559
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CS4867 | Other | ID | ID STATE BOARD OF PHARMAC |
| D-1762 | Other | ID | ID STATE BOARD OF DENTIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-1762 | ID | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861600330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4591",
"city": "KETCHUM",
"state": "ID",
"postal_code": "833404591",
"telephone_number": "208-726-7559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 2ND AVE. NORTH",
"city": "KETCHUM",
"state": "ID",
"postal_code": "83340",
"telephone_number": "208-726-7559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPECTOR",
"first_name": "WAYNE",
"middle_name": "JULIAN",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D-1762",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ID STATE BOARD OF PHARMAC",
"identifier": "CS4867",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ID STATE BOARD OF DENTIST",
"identifier": "D-1762",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ketchum, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.