| Organization Name: | SMILES 4 KIDS BURLEY |
| NPI Number: | 1346510237 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRENT GRAFF PRYOR (DENTIST) |
| Mailing Address: | 1408 Pomerelle Ave Suite D Burley |
| State: | ID US |
| Postal Code: | 833182064 |
| Phone Number: | 2087347415 |
| Fax Number: | 2087331922 |
| NPI Enumeration Date: | 01/09/2012 |
| NPI Last Update Date: | 11/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 1223P0221X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |