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Organization
IDAHO SMILES ASSOC. PLLS
Active
Organization
IDAHO SMILES ASSOC. PLLS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFF TULLER DDS (OWNER/DENTIST)
(208) 343-7271
Entity
Organization
Contact information
Practice address
305 W IDAHO ST, BOISE, ID 83702-6040
(208) 343-7271
Mailing address
305 W IDAHO ST, BOISE, ID 83702-6040
(208) 343-7271
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-2065
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285641589
NPI
ID
Enumeration date
11/01/2010
Last updated
11/01/2010
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