Boise Orthodontics P.a.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D-3036-OR Issued in ID

Legal business name

BOISE ORTHODONTICS P.A.

Practice address

4725 N Cloverdale Rd
Suite 101
Boise, ID 83713-4911

Phone

(208) 323-4458

NPI assigned

Mar 13, 2008

Last updated

Mar 13, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Glen Allen Smith, DDS MSNPI 1154338812

Title

Owner

Phone

(208) 323-4458

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glen Allen Smith, DDS MS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Boise, ID
  • NPI 1154338812
  Authorized official Same address or phone
• Anthony Mongillo, D.M.D, M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Idaho Falls, ID
  • NPI 1669886982
  NPD (past)

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

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1770754186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4725 N CLOVERDALE RD",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837134911",
            "telephone_number": "208-323-4458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 N CLOVERDALE RD",
            "address_2": "SUITE 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837134911",
            "telephone_number": "208-323-4458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOISE ORTHODONTICS P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-13",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-323-4458",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "D-3036-OR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID",
            "identifier": "6L271",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "734506",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Boise Plastic Surgery Boise Hand Center PLLC (Boise Hand Center)
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• Orthodontics and Dentofacial Orthopedics Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; 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.