Healthcare Provider Details

I. General information

NPI: 1013479542
Provider Name (Legal Business Name): A REASON TO SMILE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 N BOGUS BASIN RD
BOISE ID
83702-0913
US

IV. Provider business mailing address

2803 N BOGUS BASIN RD
BOISE ID
83702-0913
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-1393
  • Fax: 208-388-8462
Mailing address:
  • Phone: 208-343-1393
  • Fax: 208-388-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: CRAIG R SMITH
Title or Position: OWNER
Credential: DDS
Phone: 208-343-1393