TY C. CORBRIDGE DMD PC NPI 1851627103

NPI Information

TY C. CORBRIDGE, DMD, PC is a dental clinic center in Sandpoint, ID. TY C. CORBRIDGE, DMD, PC NPI is 1851627103. The provider is registered as an organization entity type.
The provider Is Doing Business As Mountain Lake Dental.

The provider's business location address is:

1323 MICHIGAN ST
SANDPOINT, ID
ZIP 83864-747
Phone: (208) 265-1705
Fax: (208) 265-1795

The provider's authorized official is Ty C Corbridge .
The authorized official title is Owner and has the following contact phone number (208) 265-1705.

The enumeration date for this NPI number is 10/21/2009 and was last updated on 10/21/2009.

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:

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