Organization
SMILES 4 KIDS JACKSON LLC
Active
Other names
Smiles 4 Kids
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KORY D BINGHAM D.D.S. (OWNER)
(208) 716-9724
Entity
Organization
Contact information
Practice address
1315 S HWY 89, SUITE 102, JACKSON, WY 83001-8514
(208) 716-9724
Mailing address
PO BOX 191, IONA, ID 83427-0191
(208) 716-9724
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1361
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124183207
—
WY
Enumeration date
03/19/2012
Last updated
04/09/2015
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