| Teton Valley Dental Center Pllc | |
|
235 E. Wallace Ave. Driggs ID 83422-0791 | |
| (208) 354-8181 | |
| (208) 354-8182 |
| Full Name | Teton Valley Dental Center Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 235 E. Wallace Ave., Driggs, Idaho |
| Authorized Official Name and Position | Susette Brizzee (OFFICE MANAGER) |
| Authorized Official Contact | 2083548181 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Teton Valley Dental Center Pllc Po Box 791 235 E Wallace Ave. Driggs ID 83422-0791 Ph: (208) 354-8181 | Teton Valley Dental Center Pllc 235 E. Wallace Ave. Driggs ID 83422-0791 Ph: (208) 354-8181 |
| NPI Number | 1801112628 |
|---|---|
| Provider Enumeration Date | 04/19/2010 |
| Last Update Date | 04/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801112628 | NPI | - | NPPES |
| 001212401 | Medicaid | ID | |
| 80597001 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D-1657 (Idaho) | Primary |
| 261QD0000X | Clinic/center - Dental | D3634 (Idaho) | Secondary |
Neerings Dental Inc, Dba Teton Valley Dental Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 235 Wallace Ave, Driggs, ID 83422 Phone: 208-354-8181 Fax: 208-354-8182 | |
Teton Valley Dental Center Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 235 E. Wallace Ave., Driggs, ID 83442 Phone: 208-354-8181 Fax: 208-354-8182 | |
Cottonwood Dental Care, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 180 S Main St, Suite B2, Driggs, ID 83422 Phone: 208-354-9700 Fax: 208-354-9701 | |
Enduradent Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 33 East Harper Ave, Driggs, ID 83422 Phone: 208-521-7888 |