Individual
TYLER J SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2200 E WARM SPRINGS AVE STE 108, BOISE, ID 83712
(208) 830-4438
(208) 392-1384
Mailing address
2200 E WARM SPRINGS AVE STE 108, BOISE, ID 83712-8405
(208) 343-2000
(208) 392-1384
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3898
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010157744
BLUESHIELD OF IDAHO #
ID
01
—
CS11082
IDAHO CONTROLLED SUBSTANC
ID
01
—
D-3898
IDAHO DENTISTRY LICENSE
ID
Enumeration date
03/06/2007
Last updated
03/07/2023
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