# SNOWY RIVER DENTAL PLLC

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

## Provider details

- **NPI number:** 1346606621
- **Authorized official:** DR. DANTON LAFEY BRADSHAW D.D.S. (OWNER)
- **Authorized official phone:** (208) 670-0113

## Contact information

- **Practice address:** 304 S MAIN ST, BELLEVUE, ID 83313-6057
- **Practice address phone:** (208) 788-2006
- **Mailing address:** 304 S MAIN ST, BELLEVUE, ID 83313-6057
- **Mailing address phone:** (208) 788-2006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D4642 | ID | Yes |

## Other

- **Enumeration date:** 01/02/2016
- **Last updated:** 01/02/2016