Provider Demographics
NPI:1700312907
Name:AESTHETIC SMILES P LLC
Entity Type:Organization
Organization Name:AESTHETIC SMILES P LLC
Other - Org Name:ALPINE HEIGHTS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LECHUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-888-1802
Mailing Address - Street 1:2015 N LOCUST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1827
Mailing Address - Country:US
Mailing Address - Phone:208-888-1802
Mailing Address - Fax:208-887-3908
Practice Address - Street 1:2015 N LOCUST GROVE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1827
Practice Address - Country:US
Practice Address - Phone:208-888-1802
Practice Address - Fax:208-887-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD42251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty