Justin Craig Smith, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D3526 Issued in ID

Practice address

1105 3Rd Ave North
Payette, ID 83661

Phone

(208) 642-9763

Fax

(208) 642-3554

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Integrity Care Dental LLC

  • Dental Clinic/Center
  • Payette, ID
  • NPI 1306603386
  NPD Authorized official

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1831279538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 3RD AVE NORTH",
            "city": "PAYETTE",
            "state": "ID",
            "postal_code": "83661",
            "telephone_number": "208-642-9763",
            "fax_number": "208-642-3554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 3RD AVE NORTH",
            "city": "PAYETTE",
            "state": "ID",
            "postal_code": "83661",
            "telephone_number": "208-642-9763",
            "fax_number": "208-642-3554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JUSTIN",
        "middle_name": "CRAIG",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806078600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Marie Ryan, LPC
• Sagebrush Therapeutic Services PLLC
• Cristy Lynn Schroeder, LMSW
• Michael Seward
• Andrew Silsby, FNP-C
• Snake River Dental Inc.
• Spooner Eye Care SC
• Carolyn Anderson St. Germain, LCSW
• Jordan Alexis St. Martin
• Phillip E Stevenson, PA-C

• Dentist in Payette, ID
• Providers in Payette, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.