Organization
TEN MILE SMILES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WARREN R WILLIS DMD (PRESIDENT)
(208) 887-9000
Entity
Organization
Contact information
Practice address
2700 W CHERRY LN, STE 120, MERIDIAN, ID 83642-1500
(208) 887-9000
(208) 887-9107
Mailing address
2700 W CHERRY LN, STE 120, MERIDIAN, ID 83642-1500
(208) 887-9000
(208) 887-9107
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4721
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235336827
NPI
ID
01
—
1568535011
NPI
ID
Enumeration date
06/20/2016
Last updated
06/20/2016
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