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Organization
SNOWY RIVER DENTAL PLLC
Active
Organization
SNOWY RIVER DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANTON LAFEY BRADSHAW D.D.S. (OWNER)
(208) 670-0113
Entity
Organization
Contact information
Practice address
304 S MAIN ST, BELLEVUE, ID 83313-6057
(208) 788-2006
Mailing address
304 S MAIN ST, BELLEVUE, ID 83313-6057
(208) 788-2006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4642
ID
Other
Enumeration date
01/02/2016
Last updated
01/02/2016
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