Broadway Smiles

NPI #1275999872 in Idaho Falls, Idaho

Provider Information

NPI Number: 1275999872
Entity Type: Organization
Organization Name: Broadway Smiles
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Jan 12, 2016
Last Updated: Jan 12, 2016

Practice Location

Address: 505 1ST ST STE B
City: Idaho Falls
State: Idaho
ZIP Code: 83401-3929
Phone: (208) 529-1903

Authorized Official

Name: NATALY PENUELAS
Title: OFFICE MANAGER
Phone: (208) 680-0186

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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