| Grand Teton Dental Care | |
|
741 South 50 West Suite A Victor ID 83455 | |
| (208) 787-2323 | |
| (208) 787-2464 |
| Full Name | Grand Teton Dental Care |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 741 South 50 West, Victor, Idaho |
| Authorized Official Name and Position | Elmer Raymond Cherry (OWNER) |
| Authorized Official Contact | 2087872323 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Teton Dental Care 741 South 50 West Suite A Victor ID 83455 Ph: (208) 787-2323 | Grand Teton Dental Care 741 South 50 West Suite A Victor ID 83455 Ph: (208) 787-2323 |
| NPI Number | 1336457837 |
|---|---|
| Provider Enumeration Date | 09/17/2010 |
| Last Update Date | 09/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336457837 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D-4235 (Idaho) | Primary |
Mountain River Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 7726 Lupine Ln, Victor, ID 83455 Phone: 208-787-8100 | |
Mountain River Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 Lupine Dr., Victor, ID 83455 Phone: 208-787-8100 Fax: 208-787-8101 | |
Mountain River Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 Lupine Drive, Victor, ID 83455 Phone: 208-787-8100 Fax: 208-787-8101 | |
Grand Teton Denteal Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 741 S 50 W, Suite A, Victor, ID 83455 Phone: 208-787-2323 |