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Organization
MOUNTAIN VIEW DENTAL CLINIC
Active
Organization
MOUNTAIN VIEW DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY H WALKER DMD (OWNER)
(208) 547-2220
Entity
Organization
Contact information
Practice address
390 SOUTH 3RD WEST, SODA SPRINGS, ID 83276
(208) 547-2220
(208) 547-2224
Mailing address
390 SOUTH 3RD WEST, SODA SPRINGS, ID 83276
(208) 547-2220
(208) 547-2224
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D3839
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807893200
—
ID
01
—
9203147
IDAHO SMILES-MEDICAID
ID
Enumeration date
03/17/2008
Last updated
05/26/2009
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