Provider Demographics
NPI:1164684312
Name:AESTHETIC SMILES
Entity type:Organization
Organization Name:AESTHETIC SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:AUSTEN
Authorized Official - Last Name:PILLING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-888-0662
Mailing Address - Street 1:4795 N SUMMIT WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5017
Mailing Address - Country:US
Mailing Address - Phone:208-888-0662
Mailing Address - Fax:208-888-0863
Practice Address - Street 1:4795 N SUMMIT WAY STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5017
Practice Address - Country:US
Practice Address - Phone:208-888-0662
Practice Address - Fax:208-888-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD38771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty