Organization
LEGACY SMILES FAMILY DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD J WILLIAMS DDS (PARTNER)
(208) 888-3311
Entity
Organization
Contact information
Practice address
1180 N OLIVE AVE, MERIDIAN, ID 83642-5920
(208) 888-3311
(208) 888-1691
Mailing address
1180 N OLIVE AVE, MERIDIAN, ID 83642-5920
(208) 888-3311
(208) 888-1691
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3220
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002799500
—
ID
05
—
002799600
—
ID
05
—
806233700
—
ID
Enumeration date
08/16/2006
Last updated
05/12/2016
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