| Smiles By Design | |
|
135 Warren Ave Pocatello ID 83201-4621 | |
| (208) 237-6453 | |
| (208) 233-4227 |
| Full Name | Smiles By Design |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 135 Warren Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Richard Lamonte Page (PRESIDENT) |
| Authorized Official Contact | 2082376453 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smiles By Design 135 Warren Ave Pocatello ID 83201-4621 Ph: (208) 237-6453 | Smiles By Design 135 Warren Ave Pocatello ID 83201-4621 Ph: (208) 237-6453 |
| NPI Number | 1053400580 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 09/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053400580 | NPI | - | NPPES |
| 806402100 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D3606 (Idaho) | Primary |
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