Healthcare Provider Details

I. General information

NPI: 1306603386
Provider Name (Legal Business Name): INTEGRITY CARE DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 3RD AVE N
PAYETTE ID
83661-2407
US

IV. Provider business mailing address

1105 3RD AVE N
PAYETTE ID
83661-2407
US

V. Phone/Fax

Practice location:
  • Phone: 208-642-9763
  • Fax: 208-642-3554
Mailing address:
  • Phone: 208-642-9763
  • Fax: 208-642-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN CRAIG SMITH
Title or Position: OWNER
Credential: DMD
Phone: 208-642-9763