Provider Demographics
NPI:1568803203
Name:SMILES 4 KIDS HAILEY
Entity Type:Organization
Organization Name:SMILES 4 KIDS HAILEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-760-0335
Mailing Address - Street 1:317 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8426
Mailing Address - Country:US
Mailing Address - Phone:208-731-8726
Mailing Address - Fax:
Practice Address - Street 1:317 S RIVER ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8426
Practice Address - Country:US
Practice Address - Phone:208-731-8726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty