Individual
JUSTIN CRAIG SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1105 3RD AVE NORTH, PAYETTE, ID 83661
(208) 642-9763
(208) 642-3554
Mailing address
1105 3RD AVE NORTH, PAYETTE, ID 83661
(208) 642-9763
(208) 642-3554
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3526
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806078600
—
ID
Enumeration date
10/17/2006
Last updated
03/20/2024
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