# LEGACY SMILES FAMILY DENTAL, PLLC

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

## Provider details

- **NPI number:** 1275646259
- **Authorized official:** BRAD J WILLIAMS DDS (PARTNER)
- **Authorized official phone:** (208) 888-3311

## Contact information

- **Practice address:** 1180 N OLIVE AVE, MERIDIAN, ID 83642-5920
- **Practice address phone:** (208) 888-3311
- **Practice address fax:** (208) 888-1691
- **Mailing address:** 1180 N OLIVE AVE, MERIDIAN, ID 83642-5920
- **Mailing address phone:** (208) 888-3311
- **Mailing address fax:** (208) 888-1691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3220 | ID | Yes |

## Other

- **Enumeration date:** 08/16/2006
- **Last updated:** 05/12/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002799500 | — | ID |
| 05 | — | 002799600 | — | ID |
| 05 | — | 806233700 | — | ID |