Organization
EAGLE ROCK DENTAL CARE PLLC
Active
Parent organization
EAGLE ROCK DENTAL CARE PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAGLE ROCK DENTAL CARE PLLC
Authorized official
TRUDEE L CHAPPLE (OFFICE ADMINISTRATOR)
(208) 523-5400
Entity
Organization
Contact information
Practice address
2205 CHANNING WAY STE B, IDAHO FALLS, ID 83404-8016
(208) 529-3660
(208) 529-3666
Mailing address
2205 CHANNING WAY STE B, IDAHO FALLS, ID 83404-8016
(208) 529-3660
(208) 529-3666
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D1608
ID
1223G0001X
General Practice Dentistry
D1890
ID
1223G0001X
General Practice Dentistry
Primary
D3063
ID
1223G0001X
General Practice Dentistry
D4036
ID
1223G0001X
General Practice Dentistry
D4138
ID
1223G0001X
General Practice Dentistry
D4369
ID
Other
Enumeration date
08/09/2012
Last updated
08/24/2012
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