# COUCH-BURTENSHAW DENTAL

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

## Provider details

- **NPI number:** 1770725772
- **Authorized official:** MISS REANA LYN (OFFICE MANAGER)
- **Authorized official phone:** (208) 359-5454

## Contact information

- **Practice address:** 1014 ERIKSON DR, REXBURG, ID 83440-5297
- **Practice address phone:** (208) 359-5454
- **Practice address fax:** (208) 359-0749
- **Mailing address:** 1014 ERIKSON DR, REXBURG, ID 83440-5297
- **Mailing address phone:** (208) 359-5454
- **Mailing address fax:** (208) 359-0749

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1303 | ID | Yes |

## Other

- **Enumeration date:** 04/06/2009
- **Last updated:** 04/06/2009