# SANDPOINT DENTAL COSMETICS, PLLC

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

## Provider details

- **NPI number:** 1083933741
- **Authorized official:** DR. JOSEPH JOHNSON DMD (DOCTOR)
- **Authorized official phone:** (208) 255-1255

## Contact information

- **Practice address:** 30336 HIGHWAY 200, SUITE A, PONDERAY, ID 83852-9775
- **Practice address phone:** (208) 255-1255
- **Practice address fax:** (208) 263-0490
- **Mailing address:** 30336 HIGHWAY 200, SUITE A, PONDERAY, ID 83852-9775
- **Mailing address phone:** (208) 255-1255
- **Mailing address fax:** (208) 263-0490

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D4103 | ID | Yes |

## Other

- **Enumeration date:** 05/20/2010
- **Last updated:** 02/21/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1831385590 | NPI TYPE ONE | ID |