| Grand Teton Denteal Care | |
|
741 S 50 W Suite A Victor ID 83455-5345 | |
| (208) 787-2323 | |
| Not Available |
| Full Name | Grand Teton Denteal Care |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 741 S 50 W, Victor, Idaho |
| Authorized Official Name and Position | Jeffrey Wildan Bowman (OWNER - DENTIST) |
| Authorized Official Contact | 2087872323 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Teton Denteal Care 741 S 50 W Suite A Victor ID 83455-5345 Ph: (208) 787-2323 | Grand Teton Denteal Care 741 S 50 W Suite A Victor ID 83455-5345 Ph: (208) 787-2323 |
| NPI Number | 1922269331 |
|---|---|
| Provider Enumeration Date | 06/18/2008 |
| Last Update Date | 06/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922269331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D3162 (Idaho) | Primary |
Mountain River Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 7726 Lupine Ln, Victor, ID 83455 Phone: 208-787-8100 | |
Grand Teton Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 741 South 50 West, Suite A, Victor, ID 83455 Phone: 208-787-2323 Fax: 208-787-2464 | |
Mountain River Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 Lupine Dr., Victor, ID 83455 Phone: 208-787-8100 Fax: 208-787-8101 | |
Mountain River Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 404 Lupine Drive, Victor, ID 83455 Phone: 208-787-8100 Fax: 208-787-8101 |