Provider Demographics
NPI:1861926677
Name:LITTLE SMILES PEDIATRIC DENTISTRY PC
Entity type:Organization
Organization Name:LITTLE SMILES PEDIATRIC DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-777-9331
Mailing Address - Street 1:602 N CALGARY CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 N CALGARY CT
Practice Address - Street 2:SUITE 201
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4000
Practice Address - Country:US
Practice Address - Phone:208-777-9331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3781-PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID28639Medicaid