Organization
INNOVATIVE SLEEP & TMJ CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL B SMITH DMD (MANAGER)
(208) 870-6288
Entity
Organization
Contact information
Practice address
1720 W MCMILLAN RD, MERIDIAN, ID 83646-6892
(208) 216-6110
Mailing address
1720 W MCMILLAN RD, MERIDIAN, ID 83646-6892
(208) 216-6110
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
11/14/2023
Last updated
11/21/2024
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