Organization
BACKCOUNTRY DENTAL DOCS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HILLARY ANNE BERRY DMD (MANAGER)
(425) 409-1655
Entity
Organization
Contact information
Practice address
109 MCKINLEY AVE, KELLOGG, ID 83837-2501
(208) 784-0545
Mailing address
2691 E THOMAS HILL DR, COEUR D ALENE, ID 83815-6335
(425) 409-1655
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21014
—
ID
Enumeration date
06/26/2019
Last updated
10/03/2022
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