Organization
BEARABLE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA GORDON O.P.P. (DIRECTOR OF INSURANCE COORDINATION)
(208) 882-3214
Entity
Organization
Contact information
Practice address
1410 S MAIN ST, MOSCOW, ID 83843-8930
(208) 882-3214
Mailing address
1410 S MAIN ST, MOSCOW, ID 83843-8930
(208) 882-3214
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS2043
CONTROLLED SUBSTANCE #
ID
01
—
CS9172
CONTROLLED SUBSTANCE
ID
01
—
CS9246
CONTROLLED SUBSTANCE NUMB
ID
01
—
D-3556
DENTAL
ID
01
—
D-3565
DENTAL
ID
Enumeration date
07/23/2006
Last updated
03/07/2023
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