Organization
TOWNE SUARE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD H. GEORGE DMD (OWNER)
(208) 745-8704
Entity
Organization
Contact information
Practice address
527 RIGBY LAKE DR, SUITE B, RIGBY, ID 83442-1271
(208) 745-8704
(208) 745-7052
Mailing address
527 RIGBY LAKE DR STE B, RIGBY, ID 83442-1271
(208) 745-8704
(208) 745-7052
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1828
ID
1223G0001X
General Practice Dentistry
D3820
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69054
BLUE CROSS OF IDAHO
ID
01
—
6K356
BLUE CROSS OF IDAHO
ID
Enumeration date
06/04/2007
Last updated
08/22/2020
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