Mountain River Dental PLLC
Organization Active NPI Dentist · Victor, ID
NPI 1093147696 · NPPES record last updated Aug 6, 2013
Key facts
- NPI
- 1093147696
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- D-4169 (ID)
- Legal business name
- MOUNTAIN RIVER DENTAL PLLC
- Practice address
- 7726 Lupine LN
Victor, ID 83455-5116 - Phone
- (208) 787-8100
- NPI assigned
- Aug 6, 2013
- Organization subpart
- No
Authorized official
- Name
- Dr. Curtis W Carpenter, D.D.S.
- Title
- President
- Phone
- (208) 201-8649
Practitioners 2
-
Nathan Richard George, D.D.S.
-
Tristan Taylor, D.D.S.
National Provider Directory
Locations
7726 Lupine Ln
Victor, ID 83455
Phone (208) 787-8100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | D-4169 | ID | Yes |
Addresses
Primary practice location
7726 Lupine LN
Victor, ID 83455-5116
Mailing address
7726 Lupine LN
Victor, ID 83455-5116
Phone (208) 787-8100
Other providers in Victor, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.