| Snake River Dental Inc. | |
|
925 2nd Ave N Payette ID 83661-2511 | |
| (208) 642-4782 | |
| Not Available |
| Full Name | Snake River Dental Inc. |
|---|---|
| Speciality | Dentist |
| Location | 925 2nd Ave N, Payette, Idaho |
| Authorized Official Name and Position | James H. Moore (PRESIDENT/DENTIST) |
| Authorized Official Contact | 2086424782 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Snake River Dental Inc. 925 2nd Ave N Payette ID 83661-2511 Ph: (208) 642-4782 | Snake River Dental Inc. 925 2nd Ave N Payette ID 83661-2511 Ph: (208) 642-4782 |
| NPI Number | 1932360674 |
|---|---|
| Provider Enumeration Date | 06/24/2008 |
| Last Update Date | 06/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932360674 | NPI | - | NPPES |
| 807498800 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D3950 (Idaho) | Primary |
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