Organization
ID SDS II PLLC
Active
Parent organization
ID SPECIALTY DENTAL SERVICES, PLLC
Other names
Super Smiles Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
ID SPECIALTY DENTAL SERVICES, PLLC
Authorized official
CHARLOTTE V DASCH (DIRECTOR OF CREDENTIALING)
(504) 638-0303
Entity
Organization
Contact information
Practice address
1541 S TIMESQUARE LN, BOISE, ID 83709-8266
(208) 321-7006
Mailing address
1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
(615) 678-0759
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
05/29/2024
Last updated
03/03/2025
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