=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437692118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVERSTONE FAMILY DENTAL, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2016
-----------------------------------------------------
Last Update Date | 11/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2026 S EAGLE RD
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-6707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-888-3623
-----------------------------------------------------
Fax | 208-888-9712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2026 S EAGLE RD
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-6707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-888-3623
-----------------------------------------------------
Fax | 208-888-9712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GRAHAM I. HILL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 208-888-3623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | D3559
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------