Provider Demographics
NPI:1639358773
Name:NATURAL SMILE DENTAL PLLC
Entity Type:Organization
Organization Name:NATURAL SMILE DENTAL PLLC
Other - Org Name:STAR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-286-9890
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669
Mailing Address - Country:US
Mailing Address - Phone:208-286-9890
Mailing Address - Fax:208-286-9924
Practice Address - Street 1:10706 W STATE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669
Practice Address - Country:US
Practice Address - Phone:208-286-9890
Practice Address - Fax:208-286-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD35371223G0001X
IDD36091223G0001X
IDD40091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty