| Snowy River Dental Pllc | |
|
304 S Main St Bellevue ID 83313-6057 | |
| (208) 788-2006 | |
| Not Available |
| Full Name | Snowy River Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 304 S Main St, Bellevue, Idaho |
| Authorized Official Name and Position | Danton Lafey Bradshaw (OWNER) |
| Authorized Official Contact | 2086700113 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Snowy River Dental Pllc 304 S Main St Bellevue ID 83313-6057 Ph: (208) 788-2006 | Snowy River Dental Pllc 304 S Main St Bellevue ID 83313-6057 Ph: (208) 788-2006 |
| NPI Number | 1346606621 |
|---|---|
| Provider Enumeration Date | 01/02/2016 |
| Last Update Date | 01/02/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346606621 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D4642 (Idaho) | Primary |