=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659619609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAGLE SMILES DENTISTRY AND ORTHODONTICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2013
-----------------------------------------------------
Last Update Date | 01/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6700 N LINDER RD STE 132
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83646-6608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-895-8555
-----------------------------------------------------
Fax | 208-895-8556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2860 MICHELLE FL 2
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92606-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-368-2077
-----------------------------------------------------
Fax | 714-508-6400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DOCTOR
-----------------------------------------------------
Name | DR. DANIEL B HOWARD
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 208-895-8555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------