Broadway Smiles

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D-4109 Issued in ID

Legal business name

BROADWAY SMILES

Doing business as

Signature Smiles

Practice address

505 1St St Ste B
Idaho Falls, ID 83401-3929

Phone

(208) 529-1903

Fax

(208) 529-1925

NPI assigned

Jan 12, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nataly Penuelas

Title

Office Manager

Phone

(208) 680-0186

Specialties & licenses 1

Addresses

Other names 1

• Signature Smiles Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452556800000",
    "number": "1275999872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 1ST ST STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834013929",
            "telephone_number": "208-529-1903",
            "fax_number": "208-529-1925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 1ST ST STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834013929",
            "telephone_number": "208-529-1903",
            "fax_number": "208-529-1925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-12",
        "last_updated": "2016-01-12",
        "status": "A",
        "authorized_official_last_name": "PENUELAS",
        "authorized_official_first_name": "NATALY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-680-0186"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D-4109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Signature Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.