# IDAHO SMILES ASSOC. PLLS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003116542
- **Authorized official:** DR. JEFF TULLER DDS (OWNER/DENTIST)
- **Authorized official phone:** (208) 343-7271

## Contact information

- **Practice address:** 305 W IDAHO ST, BOISE, ID 83702-6040
- **Practice address phone:** (208) 343-7271
- **Mailing address:** 305 W IDAHO ST, BOISE, ID 83702-6040
- **Mailing address phone:** (208) 343-7271

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-2065 | ID | Yes |

## Other

- **Enumeration date:** 11/01/2010
- **Last updated:** 11/01/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1285641589 | NPI | ID |