Organization
MOUNTAIN RIVER DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD H GEORGE D.M.D. (OWNER)
(208) 787-8100
Entity
Organization
Contact information
Practice address
404 LUPINE DRIVE, VICTOR, ID 83455-0487
(208) 787-8100
(208) 787-8101
Mailing address
404 LUPINE DRIVE P.O. BOX 487, VICTOR, ID 83455-0487
(208) 787-8100
(208) 787-8101
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/06/2009
Last updated
07/06/2009
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