Provider Demographics
NPI:1306603386
Name:INTEGRITY CARE DENTAL LLC
Entity type:Organization
Organization Name:INTEGRITY CARE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-642-9763
Mailing Address - Street 1:1105 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-2407
Mailing Address - Country:US
Mailing Address - Phone:208-642-9763
Mailing Address - Fax:208-642-3554
Practice Address - Street 1:1105 3RD AVE N
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2407
Practice Address - Country:US
Practice Address - Phone:208-642-9763
Practice Address - Fax:208-642-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental