Organization
IDAHO SMILES ASSOC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY TULLER DDS (OWNER)
(208) 343-7271
Entity
Organization
Contact information
Practice address
305 W IDAHO ST, BOISE, ID 83702-6040
(208) 343-7271
(888) 375-3163
Mailing address
305 W IDAHO ST, BOISE, ID 83702-6040
(208) 343-7271
(888) 375-3163
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D 2065
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285641589
INDIVIDUAL NPI
—
Enumeration date
10/18/2010
Last updated
10/18/2010
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