# CHANNING WAY DENTAL DBA LOST RIVERS DENTAL

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

## Provider details

- **NPI number:** 1588786875
- **Authorized official:** DR. COREY CHRISTENSE D.D.S. (PARTNER)
- **Authorized official phone:** (208) 527-3472

## Contact information

- **Practice address:** 520 HIGHLAND DRIVE, ARCO, ID 83213
- **Practice address phone:** (208) 527-3472
- **Practice address fax:** (208) 527-8955
- **Mailing address:** PO BOX 5, ARCO, ID 83213-0005
- **Mailing address phone:** (208) 527-3472
- **Mailing address fax:** (208) 527-8955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3703 | ID | Yes |

## Other

- **Enumeration date:** 04/06/2007
- **Last updated:** 03/25/2008