Organization
EAGLE RIVER DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLY SUZANNE RAICHART DDS (CEO)
(970) 926-1519
Entity
Organization
Contact information
Practice address
0057 EDWARDS ACCESS ROAD, SUITE 21, EDWARDS, CO 81632-1478
(970) 926-1519
(970) 926-1044
Mailing address
PO BOX 1478, EDWARDS, CO 81632-1478
(970) 926-1519
(970) 926-1044
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7209
CO
Other
Enumeration date
04/16/2008
Last updated
04/16/2008
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