DR. GLEN ALLEN SMITH (NPI# 1154338812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154338812 |
| Entity Type | Individual |
| Full Name | DR. GLEN ALLEN SMITH |
| Credential | DDS MS |
| Practice Address |
4725 N Cloverdale Rd Boise ID 83713 |
| Mailing Address |
869 E Antilles Crt Meridian ID 83642 |
| Practice Telephone | 2083234458 |
| Practice Fax Number | 2083211706 |
| Mailing Telephone | 2088871718 |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
D30360R | ID | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UNITED CONCORDIA | 734506 | 01 | |
| BLUE CROSS ID | 6L271 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851944565 | Glen Michael Smith | Community Health Worker | 2200 4th St, Baker City, OR 97814-2615 | 2019-07-22 |
| 1912096579 | Glen Scott Smith | Family Medicine | 2501 E Chapman Ave, Orange, CA 92869-3204 | 2006-10-12 |
| 1346336146 | Glen E Smith | Technician/Technologist | 9525 Queens Blvd, Rego Park, NY 11374-4511 | 2006-10-05 |
| 1235147349 | Glen Allen Smith | Internal Medicine | 1901 S 1st St, Temple, TX 76504-7451 | 2006-08-04 |
| 1326031105 | Glen B Smith | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1505 Eastland Dr, Suite 210, Bloomington, IL 61701-7906 | 2005-08-26 |
| Street Address |
4725 N CLOVERDALE RD |
| City | BOISE |
| State | ID |
| Zip Code | 83713 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669886982 | Anthony Mongillo | Dentist | 4725 N Cloverdale Rd, Suite 101, Boise, ID 83713-4911 | 2014-06-13 |
| 1770754186 | Boise Orthodontics P.a. | Dentist | 4725 N Cloverdale Rd, Suite 101, Boise, ID 83713-4911 | 2008-03-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801061080 | Laura Kathleen Lineberry | Dentist | 13059 W Persimmon Ln, Boise, ID 83713-1986 | 2008-04-28 |
| 1194910778 | Scott D Alexander | Dentist | 3167 South Bown Way, Boise, ID 83706 | 2007-09-07 |
| 1952504318 | Jacob Reed Jarivs | Dentist | 6000 S Quamash Way, Boise, ID 83716-5617 | 2007-06-05 |
| 1588879399 | Jon Miler | Dentist | 5220 N Eagle Rd, Boise, ID 83713-0945 | 2007-05-14 |
| 1194814251 | Steven David Gilman | Dentist | 7301 W Emerald St Ste 101, Boise, ID 83704-8689 | 2006-10-12 |
| 1396843058 | Marcus Lowry | Dentist | 9460 W. Franklin Rd, Boise, ID 83709 | 2006-09-20 |
| 1346344884 | John C. Slattery | Dentist | 600 E Riverpark Ln, Suite 100, Boise, ID 83706-6551 | 2006-09-12 |
| 1265535298 | James Kelly Poulsen | Dentist | 1453 W Hays, Boise, ID 83702 | 2006-09-06 |
| 1043322548 | Terrell F Tingey | Dentist | 2020 N Cole Rd, Boise, ID 83704 | 2006-08-31 |
| 1205943669 | John C Matunas | Dentist | 8000 Ustick Rd, Boise, ID 83704-5751 | 2006-08-23 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.