Legacy Smiles Family Dental, Pllc | |
1180 N Olive Ave Meridian ID 83642-5920 | |
(208) 888-3311 | |
(208) 888-1691 |
Full Name | Legacy Smiles Family Dental, Pllc |
---|---|
Speciality | Dentist - General Practice |
Location | 1180 N Olive Ave, Meridian, Idaho |
Authorized Official Name and Position | Brad J Williams (PARTNER) |
Authorized Official Contact | 2088883311 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Legacy Smiles Family Dental, Pllc 1180 N Olive Ave Meridian ID 83642-5920 Ph: (208) 888-3311 | Legacy Smiles Family Dental, Pllc 1180 N Olive Ave Meridian ID 83642-5920 Ph: (208) 888-3311 |
NPI Number | 1275646259 |
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Provider Enumeration Date | 08/16/2006 |
Last Update Date | 05/12/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275646259 | NPI | - | NPPES |
002799500 | Medicaid | ID | |
806233700 | Medicaid | ID | |
002799600 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | D3220 (Idaho) | Primary |
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