Organization
FOOTHILLS DENTAL CARE, PLLC
Active
Parent organization
FOOTHILLS DENTAL CARE, PLLC
Other names
RiverWest Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOOTHILLS DENTAL CARE, PLLC
Authorized official
MRS. MELISSA K RAICHART (INSURANCE COORDINATOR)
(208) 529-4484
Entity
Organization
Contact information
Practice address
1655 PANCHERI DR, IDAHO FALLS, ID 83402-3169
(208) 522-1911
(208) 523-4441
Mailing address
2205 CHANNING WAY, SUITE A, IDAHO FALLS, ID 83404-8016
(208) 529-4484
(208) 523-4441
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D1719
ID
122300000X
Dentist
D3464
ID
122300000X
Dentist
Primary
D3971
ID
122300000X
Dentist
D4302
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124035498
—
ID
05
—
1134356140
—
ID
05
—
1275619090
—
ID
05
—
1609952415
—
ID
05
—
1740501410
—
ID
05
—
1952317703
—
ID
Enumeration date
02/05/2013
Last updated
02/06/2013
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