MEDICARE: I SMILE DENTAL DESIGNS

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1568881852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I SMILE DENTAL DESIGNS

Provider Business Mailing Address
First Line	:	420 E SOUTH TEMPLE
Second Line	:	SUITE # 410
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1319
Country	:	US
Telephone Number	:	801-355-2202
Fax Number	:	801-355-9420

Provider Business Practice Location Address
First Line	:	420 E SOUTH TEMPLE
Second Line	:	SUITE # 410
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1319
Country	:	US
Telephone Number	:	801-355-2202
Fax Number	:	801-355-9420

Authorized Official
Title or Position	:	ASSISTANT OFFICE COORDINATOR
Name	:	MS. LARA JOHNSON
Credential	:
Telephone Number	:	801-355-2202

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	04/15/2014

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