Provider Demographics
NPI:1225142037
Name:SMILEMAKERS OF POCATELLO, PLLC
Entity Type:Organization
Organization Name:SMILEMAKERS OF POCATELLO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROMRIELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-478-5550
Mailing Address - Street 1:675 YELLOWSTONE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4511
Mailing Address - Country:US
Mailing Address - Phone:208-478-5700
Mailing Address - Fax:208-478-1181
Practice Address - Street 1:675 YELLOWSTONE AVE STE E
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4511
Practice Address - Country:US
Practice Address - Phone:208-478-5700
Practice Address - Fax:208-478-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty