| Idaho Smiles Assoc Pllc | |
|
305 W Idaho St Boise ID 83702-6040 | |
| (208) 343-7271 | |
| (888) 375-3163 |
| Full Name | Idaho Smiles Assoc Pllc |
|---|---|
| Speciality | Dentist |
| Location | 305 W Idaho St, Boise, Idaho |
| Authorized Official Name and Position | Jeffrey Tuller (OWNER) |
| Authorized Official Contact | 2083437271 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Smiles Assoc Pllc 305 W Idaho St Boise ID 83702-6040 Ph: (208) 343-7271 | Idaho Smiles Assoc Pllc 305 W Idaho St Boise ID 83702-6040 Ph: (208) 343-7271 |
| NPI Number | 1568772028 |
|---|---|
| Provider Enumeration Date | 10/18/2010 |
| Last Update Date | 10/18/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568772028 | NPI | - | NPPES |
| 1285641589 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D 2065 (Idaho) | Primary |
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