Smith, Glen Allen
Smith, Glen Allen is an individual health care provider with primary practice located at 4725 N Cloverdale Rd , Boise ID 83713. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Smith, Glen Allen can be contacted via phone (208) 323-4458.Contact Information
Primary practice address
4725 N Cloverdale Rd
Boise ID 83713
Phone: (208) 323-4458
Fax: (208) 321-1706
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Orthodontics and Dentofacial Orthopedics | 1223X0400X | D30360R | Idaho |
Profile Details
| NPI number | 1154338812 |
|---|---|
| LBN Legal business name | Smith, Glen Allen |
| Credentials | DDS MS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 2nd, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154338812 | NPPES |
| Other | 6L271 | BLUE CROSS ID | |
| Other | 734506 | BLUE CROSS ID |
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