Organization
DOUGLAS J. SMITH
Active
Other names
Dental Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS J SMITH DDS (OWNER-DENTIST)
(208) 356-9262
Entity
Organization
Contact information
Practice address
56 PROFESSIONAL PLZ, REXBURG, ID 83440-2047
(208) 356-9262
(208) 356-4804
Mailing address
56 PROFESSIONAL PLZ, REXBURG, ID 83440-2047
(208) 356-9262
(208) 356-4804
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1433
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001193200
—
ID
Enumeration date
06/26/2008
Last updated
06/26/2008
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