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Organization
SNAKE RIVER DENTAL INC.
Active
Organization
SNAKE RIVER DENTAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES H. MOORE DDS (PRESIDENT/DENTIST)
(208) 642-4782
Entity
Organization
Contact information
Practice address
925 2ND AVE N, PAYETTE, ID 83661-2511
(208) 642-4782
Mailing address
925 2ND AVE N, PAYETTE, ID 83661-2511
(208) 642-4782
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3950
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807498800
—
ID
Enumeration date
06/24/2008
Last updated
06/24/2008
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