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General NPI Number Information
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NPI Number | 1215465471
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Entity Type | Organization
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Legal Business Name | NEW SMILE INC.
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2124 BLAINE ST
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City | CALDWELL
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State | ID
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Zip | 83605
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Country | US
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Telephone | 208-454-0311
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Fax |
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Provider Business Mailing Address
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Address Line | 2124 BLAINE ST
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City | CALDWELL
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State | ID
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Zip | 83605-4426
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Country | US
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Telephone | 208-454-0311
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTURIST
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Name | JOSH ROBERT WESTERBERG
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Credential | DENTURIST
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Telephone | 208-454-0311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | LD-92
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License Number State | ID
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