| Mountain Lake Dental | |
|
1323 Michigan St Sandpoint ID 83864-1747 | |
| (208) 265-1705 | |
| (208) 265-1795 |
| Full Name | Mountain Lake Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1323 Michigan St, Sandpoint, Idaho |
| Authorized Official Name and Position | Ty C Corbridge (OWNER) |
| Authorized Official Contact | 2082651705 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Lake Dental 1323 Michigan St Sandpoint ID 83864-1747 Ph: (208) 265-1705 | Mountain Lake Dental 1323 Michigan St Sandpoint ID 83864-1747 Ph: (208) 265-1705 |
| NPI Number | 1851627103 |
|---|---|
| Provider Enumeration Date | 10/21/2009 |
| Last Update Date | 10/21/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851627103 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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