Organization
STONE RIDGE DENTAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CURTIS CARPENTER D.D.S. (OWNER)
(208) 346-7045
Entity
Organization
Contact information
Practice address
1035 OCTOBER CV, SHELLEY, ID 83274-5068
(208) 357-0307
Mailing address
295 ANDERSON ROAD, SHELLEY, ID 83274
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
D-4169
ID
Other
Enumeration date
10/01/2008
Last updated
10/01/2008
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