| Intermountain Dental, Pc | |
|
103 Main St Priest River ID 83856-8385 | |
| (208) 448-1241 | |
| (208) 448-1242 |
| Full Name | Intermountain Dental, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 103 Main St, Priest River, Idaho |
| Authorized Official Name and Position | Mark Edward Duke (PRESIDENT) |
| Authorized Official Contact | 2084481241 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intermountain Dental, Pc 519 Jenny Ln Sandpoint ID 83864-6006 Ph: (208) 448-1241 | Intermountain Dental, Pc 103 Main St Priest River ID 83856-8385 Ph: (208) 448-1241 |
| NPI Number | 1184217168 |
|---|---|
| Provider Enumeration Date | 02/19/2021 |
| Last Update Date | 02/19/2021 |
| Medicare PECOS PAC ID | 9638588395 |
|---|---|
| Medicare Enrollment ID | O20210510000749 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184217168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Mark E Duke |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1538246301 PECOS PAC ID: 4284910324 Enrollment ID: I20210510000870 |
Priest River Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6509 Highway 2 Ste 102, Priest River, ID 83856 Phone: 208-448-2694 Fax: 208-448-1703 | |
Priest River Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 314 E Albeni Hwy, Suite 101, Priest River, ID 83856 Phone: 208-448-2694 Fax: 208-448-1703 |