MEDICARE: MERIDIAN SMILES DENTISTRY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1043562143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN SMILES DENTISTRY, PC

Provider Business Mailing Address
First Line	:	2860 MICHELLE FL 2
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92606-1008
Country	:	US
Telephone Number	:	714-368-2084
Fax Number	:	714-368-2092

Provider Business Practice Location Address
First Line	:	2274 N EAGLE RD STE 130
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-6285
Country	:	US
Telephone Number	:	208-898-5440
Fax Number	:	208-893-5441

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. DANIEL B HOWARD
Credential	:
Telephone Number	:	208-893-5440

Provider Enumeration Date	:	10/12/2012
Last Update Date	:	10/16/2012

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