Woodworth, Gerald A

Woodworth, Gerald A is an individual health care provider with primary practice located at 301 Scott Ave , Rupert ID 83350-1800. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Woodworth, Gerald A can be contacted via phone (208) 436-6406.

Contact Information

Primary practice address
301 Scott Ave Rupert ID 83350-1800
Phone: (208) 436-6406
Fax: (208) 436-9678
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X D-1363 Idaho

Profile Details

NPI number 1053341644
LBN Legal business name Woodworth, Gerald A
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 3rd, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053341644 NPPES
Idaho Other 000010009632 REGENCE BLUESHIELD
Idaho Other 560823 REGENCE BLUESHIELD
Idaho Other 1363 REGENCE BLUESHIELD
Idaho Other 6F696 REGENCE BLUESHIELD

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