# INNOVATIVE SLEEP & TMJ CENTER PLLC

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

## Provider details

- **NPI number:** 1124892773
- **Authorized official:** DR. RANDALL B SMITH DMD (MANAGER)
- **Authorized official phone:** (208) 870-6288

## Contact information

- **Practice address:** 1720 W MCMILLAN RD, MERIDIAN, ID 83646-6892
- **Practice address phone:** (208) 216-6110
- **Mailing address:** 1720 W MCMILLAN RD, MERIDIAN, ID 83646-6892
- **Mailing address phone:** (208) 216-6110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 11/14/2023
- **Last updated:** 11/21/2024