Tyler J Smith, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3898 Issued in ID

Practice address

2200 E Warm Springs Ave Ste 108
Boise, ID 83712

Phone

(208) 830-4438

Fax

(208) 392-1384

NPI assigned

Mar 6, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tyler J Smith,PA

  • General Practice Dentistry
  • Boise, ID
  • NPI 1427380203
  NPD (past) Authorized official

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1780714915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E WARM SPRINGS AVE STE 108",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837128405",
            "telephone_number": "208-343-2000",
            "fax_number": "208-392-1384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E WARM SPRINGS AVE STE 108",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83712",
            "telephone_number": "208-830-4438",
            "fax_number": "208-392-1384"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2200 E Warm Springs Ave Ste 108",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "83712",
            "country_code": "US",
            "telephone_number": "208-830-4438",
            "fax_number": "208-392-1384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TYLER",
        "middle_name": "J",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD OF IDAHO #",
            "identifier": "000010157744",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO CONTROLLED SUBSTANC",
            "identifier": "CS11082",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO DENTISTRY LICENSE",
            "identifier": "D-3898",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Lynn Smith, DO
• Tara Lynn Hendrickson Smith, LCSW
• Taylor Michael Smith, PHARMD
• Terry L Smith, RPH
• Thomas Smith, PHARMACIST
• Tyler Jonathon Smith, LAT
• Valerie Louise Smith, A.T.C., L.M.T.
• SNF Boise Operating Company LLC
• Faith Shelice Snider
• Tiffany Rae Snodgrass, LMSW

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.