| Mountain View Dental Clinic | |
|
390 South 3rd West Soda Springs ID 83276 | |
| (208) 547-2220 | |
| (208) 547-2224 |
| Full Name | Mountain View Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 390 South 3rd West, Soda Springs, Idaho |
| Authorized Official Name and Position | Jerry H Walker (OWNER) |
| Authorized Official Contact | 2085472220 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain View Dental Clinic 390 South 3rd West Soda Springs ID 83276 Ph: (208) 547-2220 | Mountain View Dental Clinic 390 South 3rd West Soda Springs ID 83276 Ph: (208) 547-2220 |
| NPI Number | 1710158886 |
|---|---|
| Provider Enumeration Date | 03/17/2008 |
| Last Update Date | 05/26/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710158886 | NPI | - | NPPES |
| 807893200 | Medicaid | ID | |
| 9203147 | Other | ID | IDAHO SMILES-MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D3839 (Idaho) | Primary |
Soda Smiles Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 180 S Main St, Soda Springs, ID 83276 Phone: 208-547-2244 Fax: 208-547-0375 |