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General NPI Number Information
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NPI Number | 1598144198
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Entity Type | Organization
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Legal Business Name | SIGNATURE SMILES
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 3200 N LESLIE WAY STE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-5362
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Country | US
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Telephone | 208-322-0024
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 N LESLIE WAY STE 110
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City | MERIDIAN
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State | ID
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Zip | 83646-5362
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Country | US
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Telephone | 208-322-0024
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MR. KENYON L OYLER
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Credential | DDS
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Telephone | 208-322-0024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D-3327
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License Number State | ID
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