Juliann Covington Willardson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D-5314 Issued in ID

Practice address

120 Desert Sage Way
Mountain Home, ID 83647-1038

Phone

(208) 587-3988

Fax

(208) 587-3324

NPI assigned

Feb 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Juliann Covington Former name

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

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.

• Midwestern University

  • Dental Clinic/Center
  • Glendale, AZ
  • NPI 1164744009
  NPD
• Glenns Ferry Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mountain Home, ID
  • NPI 1518097047
  NPD (past)

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

{
    "created_epoch": "1612656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1992397384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 DESERT SAGE WAY",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836471038",
            "telephone_number": "208-587-3988",
            "fax_number": "208-587-3324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 DESERT SAGE WAY",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836471038",
            "telephone_number": "208-587-3988",
            "fax_number": "208-587-3324"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5855 W Utopia Rd",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853085251",
            "country_code": "US",
            "telephone_number": "623-806-7010",
            "fax_number": "623-806-7010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLARDSON",
        "first_name": "JULIANN",
        "middle_name": "COVINGTON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-07",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-5314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIANN",
            "last_name": "COVINGTON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Makenzi Walsh
• Javlyn Dickson Weaver, PA
• Malinda Paige Westendorf
• Robert Weymouth, DPT
• Tara Whitney, PHARMD
• Andrea Rena Wood, LPC
• Amber Woolley, IDMT
• Maureen Wray, M.A., CCC-SLP
• Alexandra Yewcic, LPC
• Krzysztof Hendryk Ziola, MD

• All providers in Mountain Home, ID
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; 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.