MOUNTAIN VIEW DENTAL CLINIC NPI 1710158886

NPI Information

NPI: 1710158886
Provider Name: MOUNTAIN VIEW DENTAL CLINIC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
390 SOUTH 3RD WEST
SODA SPRINGS, ID
ZIP 83276
Phone: (208) 547-2220
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MOUNTAIN VIEW DENTAL CLINIC is a dental clinic center in Soda Springs, ID. MOUNTAIN VIEW DENTAL CLINIC NPI is 1710158886. The provider is registered as an organization entity type.

The provider's business location address is:

390 SOUTH 3RD WEST
SODA SPRINGS, ID
ZIP 83276
Phone: (208) 547-2220
Fax: (208) 547-2224

The provider's authorized official is Jerry H Walker .
The authorized official title is Owner and has the following contact phone number (208) 547-2220.

The enumeration date for this NPI number is 3/17/2008 and was last updated on 5/26/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	D3839	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	9203147	OTHER	IDAHO	IDAHO SMILES-MEDICAID
2	807893200	MEDICAID	IDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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