Organization
COUCH-BURTENSHAW DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS REANA LYN (OFFICE MANAGER)
(208) 359-5454
Entity
Organization
Contact information
Practice address
1014 ERIKSON DR, REXBURG, ID 83440-5297
(208) 359-5454
(208) 359-0749
Mailing address
1014 ERIKSON DR, REXBURG, ID 83440-5297
(208) 359-5454
(208) 359-0749
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1303
ID
Other
Enumeration date
04/06/2009
Last updated
04/06/2009
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