=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245978329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNRISE SMILES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2022
-----------------------------------------------------
Last Update Date | 04/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2641 S 25TH E
-----------------------------------------------------
City | AMMON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83406-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-497-0049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51662
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83405-1662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-529-4484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSHUA REID BELL
-----------------------------------------------------
Credential | D.M.D
-----------------------------------------------------
Telephone | 208-529-4484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------