Modern Smiles Pocatello PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MODERN SMILES POCATELLO PC

Practice address

1800 Flandro Dr Ste 340
Pocatello, ID 83202-4944

Phone

(208) 238-1900

NPI assigned

Oct 13, 2022

Organization subpart

No

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

Authorized official

Name

Stephanie Frank

Title

Credentialing Coordinator

Phone

(509) 570-6879

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675987200000",
    "number": "1609592435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR STE 340",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR STE 340",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024944",
            "telephone_number": "208-238-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN SMILES POCATELLO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-13",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A",
        "authorized_official_last_name": "FRANK",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "509-570-6879"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stefanie Mitchell
• Tanya Mitchell, DO
• Mya S Mitton
• Ayano Mizote, PHARM.D
• Christine Fuhrman Mladenka, DNP, WHNP
• Micah Moeai, M.S., ATC
• Kelly Mitten Moellmer
• Diane K. Moll
• Mary Paul Moller, LMFT
• Danielle Molsee, LMSW

• Dental Clinic/Center in Pocatello, ID
• Providers in Pocatello, 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 Feb 10, 2023; 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.