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Organization
SMILES FOR IDAHO
Active
Organization
SMILES FOR IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA CHRISTENSEN (OWNER)
(801) 390-1228
Entity
Organization
Contact information
Practice address
22351 AURA VISTA WAY, CALDWELL, ID 83607-5528
(801) 390-1228
Mailing address
22351 AURA VISTA WAY, CALDWELL, ID 83607-5528
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/19/2024
Last updated
11/19/2024
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