# MOUNTAIN RIVER DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093147696
- **Authorized official:** DR. CURTIS W CARPENTER D.D.S. (PRESIDENT)
- **Authorized official phone:** (208) 201-8649

## Contact information

- **Practice address:** 7726 LUPINE LN, VICTOR, ID 83455-5116
- **Practice address phone:** (208) 787-8100
- **Mailing address:** 7726 LUPINE LN, VICTOR, ID 83455-5116
- **Mailing address phone:** (208) 787-8100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D-4169 | ID | Yes |

## Other

- **Enumeration date:** 08/06/2013
- **Last updated:** 08/06/2013