Organization
GRAND TETON DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELMER RAYMOND CHERRY IV DDS (OWNER)
(208) 787-2323
Entity
Organization
Contact information
Practice address
741 SOUTH 50 WEST, SUITE A, VICTOR, ID 83455
(208) 787-2323
(208) 787-2464
Mailing address
741 SOUTH 50 WEST, SUITE A, VICTOR, ID 83455
(208) 787-2323
(208) 787-2464
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-4235
ID
Other
Enumeration date
09/17/2010
Last updated
09/17/2010
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