# TOWNE SUARE DENTAL

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

## Provider details

- **NPI number:** 1801098744
- **Authorized official:** DR. RICHARD H. GEORGE DMD (OWNER)
- **Authorized official phone:** (208) 745-8704

## Contact information

- **Practice address:** 527 RIGBY LAKE DR, SUITE B, RIGBY, ID 83442-1271
- **Practice address phone:** (208) 745-8704
- **Practice address fax:** (208) 745-7052
- **Mailing address:** 527 RIGBY LAKE DR STE B, RIGBY, ID 83442-1271
- **Mailing address phone:** (208) 745-8704
- **Mailing address fax:** (208) 745-7052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1828 | ID | Yes |
| 1223G0001X | General Practice Dentistry | D3820 | ID | — |

## Other

- **Enumeration date:** 06/04/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 69054 | BLUE CROSS OF IDAHO | ID |
| 01 | — | 6K356 | BLUE CROSS OF IDAHO | ID |