# BACKCOUNTRY DENTAL DOCS, LLC

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

## Provider details

- **NPI number:** 1235790510
- **Authorized official:** DR. HILLARY ANNE BERRY DMD (MANAGER)
- **Authorized official phone:** (425) 409-1655

## Contact information

- **Practice address:** 109 MCKINLEY AVE, KELLOGG, ID 83837-2501
- **Practice address phone:** (208) 784-0545
- **Mailing address:** 2691 E THOMAS HILL DR, COEUR D ALENE, ID 83815-6335
- **Mailing address phone:** (425) 409-1655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 06/26/2019
- **Last updated:** 10/03/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 21014 | — | ID |