# BEAR LAKE DENTAL CARE, PLLC

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

## Provider details

- **NPI number:** 1811001498
- **Authorized official:** LINDA K TIMOTHY (BUSINESS MANAGER)
- **Authorized official phone:** (208) 847-0153

## Contact information

- **Practice address:** 215 S 4TH ST, MONTPELIER, ID 83254-1591
- **Practice address phone:** (208) 847-0153
- **Practice address fax:** (208) 847-2938
- **Mailing address:** 215 S 4TH ST, PO BOX 326, MONTPELIER, ID 83254-1591
- **Mailing address phone:** (208) 847-0153
- **Mailing address fax:** (208) 847-2938

## Taxonomy

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

## Other

- **Enumeration date:** 08/19/2006
- **Last updated:** 08/22/2020