Individual
DR. TOM GUDMESTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
522 E 4TH ST, WEISER, ID 83672-2205
(208) 549-2213
(208) 549-4187
Mailing address
522 E 4TH ST, WEISER, ID 83672-2205
(208) 549-2213
(208) 549-4187
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3117
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000504200
—
ID
01
—
61937
BLUE CROSS ID PAYEE NUMBE
ID
Enumeration date
08/01/2006
Last updated
06/16/2023
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