Provider Demographics
NPI:1689047904
Name:SMILE COMPANY, PLLC
Entity Type:Organization
Organization Name:SMILE COMPANY, PLLC
Other - Org Name:GRANT DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-888-2000
Mailing Address - Street 1:2275 S EAGLE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2620
Mailing Address - Country:US
Mailing Address - Phone:208-888-2000
Mailing Address - Fax:
Practice Address - Street 1:6500 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8736
Practice Address - Country:US
Practice Address - Phone:208-893-5000
Practice Address - Fax:208-922-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty