Organization
ALLIGATOR PEDIATRIC DENTISTRY ,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY G. SMITH D.D.S (OWNER)
(208) 542-1333
Entity
Organization
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
05
—
8041268000
—
ID
Enumeration date
04/22/2008
Last updated
04/08/2024
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