Organization
RIVERSIDE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADFORD WILLIAM HARPER DDS (OWNER/PRESIDENT)
(208) 785-0878
Entity
Organization
Contact information
Practice address
1120 PARKWAY DR, BLACKFOOT, ID 83221
(208) 785-0878
(208) 785-0878
Mailing address
1120 PARKWAY DR, BLACKFOOT, ID 83221
(208) 785-0878
(208) 785-0878
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3225
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002801200
—
ID
05
—
518546704002
—
UT
Enumeration date
08/08/2006
Last updated
07/30/2008
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