| NPI | 1134885684 |
|---|---|
| Doing Business As | SMILES ON STATE STREET |
| Entity Type | Organization |
| Authorized Contact | WAYNE MORTENSEN Dr/Owner 208-853-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2023-07-06 |