Organization
ID SPECIALTY DENTAL SERVICES, PLLC
Active
Parent organization
ID SPECIALTY DENTAL SERVICES, PLLC
Other names
Riverstone Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
ID SPECIALTY DENTAL SERVICES, PLLC
Authorized official
CHARLOTTE DASCH (DIRECTOR OF CREDENTIALING & PROV RE)
(504) 638-0303
Entity
Organization
Contact information
Practice address
2140 W RIVERSTONE DR, COEUR D ALENE, ID 83814-4967
(208) 667-3209
Mailing address
1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
06/19/2023
Last updated
06/19/2023
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