# BEARABLE DENTISTRY

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

## Provider details

- **NPI number:** 1780606616
- **Authorized official:** MRS. LINDA GORDON O.P.P. (DIRECTOR OF INSURANCE COORDINATION)
- **Authorized official phone:** (208) 882-3214

## Contact information

- **Practice address:** 1410 S MAIN ST, MOSCOW, ID 83843-8930
- **Practice address phone:** (208) 882-3214
- **Mailing address:** 1410 S MAIN ST, MOSCOW, ID 83843-8930
- **Mailing address phone:** (208) 882-3214

## Taxonomy

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

## Other

- **Enumeration date:** 07/23/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CS2043 | CONTROLLED SUBSTANCE \# | ID |
| 01 | — | CS9172 | CONTROLLED SUBSTANCE | ID |
| 01 | — | CS9246 | CONTROLLED SUBSTANCE NUMB | ID |
| 01 | — | D-3556 | DENTAL | ID |
| 01 | — | D-3565 | DENTAL | ID |