Organization
SMILEMAKERS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGLA MACE (OFFICE MANAGER)
(208) 734-7246
Entity
Organization
Contact information
Practice address
142 RIVER VISTA PL, TWIN FALLS, ID 83301-3056
(208) 734-7246
Mailing address
142 RIVER VISTA PL, TWIN FALLS, ID 83301-3056
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
D-4353-PR
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20004358
MEDICARE PTAN
ID
Enumeration date
06/10/2014
Last updated
06/10/2014
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