# EAGLE RIVER DENTISTRY

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

## Provider details

- **NPI number:** 1821262361
- **Authorized official:** DR. SHELLY SUZANNE RAICHART DDS (CEO)
- **Authorized official phone:** (970) 926-1519

## Contact information

- **Practice address:** 0057 EDWARDS ACCESS ROAD, SUITE 21, EDWARDS, CO 81632-1478
- **Practice address phone:** (970) 926-1519
- **Practice address fax:** (970) 926-1044
- **Mailing address:** PO BOX 1478, EDWARDS, CO 81632-1478
- **Mailing address phone:** (970) 926-1519
- **Mailing address fax:** (970) 926-1044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 7209 | CO | Yes |

## Other

- **Enumeration date:** 04/16/2008
- **Last updated:** 04/16/2008