Provider Demographics
NPI:1407236821
Name:SMILEMAKERS DENTAL OF POCATELLO PLLC
Entity Type:Organization
Organization Name:SMILEMAKERS DENTAL OF POCATELLO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROMRIELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-478-5700
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:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty