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General NPI Number Information
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NPI Number | 1235848748
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Entity Type | Organization
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Legal Business Name | SUNNY SMILES PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 3015 EAGLE DR
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City | AMMON
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State | ID
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Zip | 83406
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Country | US
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Telephone | 208-709-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 2449 N FOOTHILL RD
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5855
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Country | US
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Telephone | 208-709-5333
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. KAILEY HOUSLEY
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Credential | DDS
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Telephone | 208-709-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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