# FOOTHILLS DENTAL CARE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FOOTHILLS DENTAL CARE, PLLC
- **Other names:** RiverWest Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205175668
- **Legal business name:** FOOTHILLS DENTAL CARE, PLLC
- **Authorized official:** MRS. MELISSA K RAICHART (INSURANCE COORDINATOR)
- **Authorized official phone:** (208) 529-4484

## Contact information

- **Practice address:** 1655 PANCHERI DR, IDAHO FALLS, ID 83402-3169
- **Practice address phone:** (208) 522-1911
- **Practice address fax:** (208) 523-4441
- **Mailing address:** 2205 CHANNING WAY, SUITE A, IDAHO FALLS, ID 83404-8016
- **Mailing address phone:** (208) 529-4484
- **Mailing address fax:** (208) 523-4441

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D1719 | ID | — |
| 122300000X | Dentist | D3464 | ID | — |
| 122300000X | Dentist | D3971 | ID | Yes |
| 122300000X | Dentist | D4302 | ID | — |

## Other

- **Enumeration date:** 02/05/2013
- **Last updated:** 02/06/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1124035498 | — | ID |
| 05 | — | 1134356140 | — | ID |
| 05 | — | 1275619090 | — | ID |
| 05 | — | 1609952415 | — | ID |
| 05 | — | 1740501410 | — | ID |
| 05 | — | 1952317703 | — | ID |