Individual
DR. RANDALL G. SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2805 EAGLE DRIVE, AMMON, ID 83406
(208) 542-1333
(208) 552-7296
Mailing address
2805 EAGLE DRIVE, AMMON, ID 83406
(208) 542-1333
(208) 552-7296
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D3257PD
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6C024
BLUE CROSS OF IDAHO
ID
05
—
804126800
—
ID
Enumeration date
02/09/2007
Last updated
04/08/2024
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