Smith, Randall G.
Smith, Randall G. is an sole proprietor health care provider with primary practice located at 2805 Eagle Drive , Ammon ID 83406. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Smith, Randall G. can be contacted via phone (208) 542-1333.Contact Information
Primary practice address
2805 Eagle Drive
Ammon ID 83406
Phone: (208) 542-1333
Fax: (208) 552-7296
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | D3257PD | Idaho |
Profile Details
| NPI number | 1659412724 |
|---|---|
| LBN Legal business name | Smith, Randall G. |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 9th, 2007 |
| Last updated | Apr 8th, 2024 - about last year |
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 | 1659412724 | NPPES |
| Idaho | Other | 6C024 | BLUE CROSS OF IDAHO |
| Idaho | MEDICAID | 804126800 | BLUE CROSS OF IDAHO |
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