| Backcountry Dental Docs, Llc | |
|
109 Mckinley Ave Kellogg ID 83837-2501 | |
| (208) 784-0545 | |
| Not Available |
| Full Name | Backcountry Dental Docs, Llc |
|---|---|
| Speciality | Dentist |
| Location | 109 Mckinley Ave, Kellogg, Idaho |
| Authorized Official Name and Position | Hillary Anne Berry (MANAGER) |
| Authorized Official Contact | 4254091655 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Backcountry Dental Docs, Llc 2691 E Thomas Hill Dr Coeur D Alene ID 83815-6335 Ph: (425) 409-1655 | Backcountry Dental Docs, Llc 109 Mckinley Ave Kellogg ID 83837-2501 Ph: (208) 784-0545 |
| NPI Number | 1235790510 |
|---|---|
| Provider Enumeration Date | 06/26/2019 |
| Last Update Date | 10/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235790510 | NPI | - | NPPES |
| 21014 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
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