# MBD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mt Baldy Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720419369
- **Authorized official:** MS. LYNN JENSEN (FINACIAL OFFICER)
- **Authorized official phone:** (208) 263-6806

## Contact information

- **Practice address:** 1305 HWY 2 WEST, BLUIDING A SUITE A, SANDPOINT, ID 83864
- **Practice address phone:** (208) 263-6806
- **Practice address fax:** (208) 265-2231
- **Mailing address:** 1305 HWY 2 WEST, BLUIDING A SUITE A, SANDPOINT, ID 83864
- **Mailing address phone:** (208) 263-6806
- **Mailing address fax:** (208) 265-2231

## Taxonomy

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

## Other

- **Enumeration date:** 12/09/2013
- **Last updated:** 12/09/2013