| River Valley Dental Care | |
|
371 W Fir St Shelley ID 83274-1456 | |
| (208) 357-7611 | |
| (208) 357-1805 |
| Full Name | River Valley Dental Care |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 371 W Fir St, Shelley, Idaho |
| Authorized Official Name and Position | Bryce D Hanson (OWNER) |
| Authorized Official Contact | 2083577611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| River Valley Dental Care Po Box 525 Shelley ID 83274-0525 Ph: (208) 357-7611 | River Valley Dental Care 371 W Fir St Shelley ID 83274-1456 Ph: (208) 357-7611 |
| NPI Number | 1851798045 |
|---|---|
| Provider Enumeration Date | 12/03/2014 |
| Last Update Date | 12/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851798045 | NPI | - | NPPES |
| 0025-57200 | Medicaid | ID | |
| 119-477-4109 | Medicaid | ID | |
| 8050-31700 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D-3275 (Idaho) | Primary |
Shelley Dental, Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 530 S State St, Shelley, ID 83274 Phone: 208-357-2400 Fax: 208-357-2414 | |
River Valley Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 371 W Fir St, Shelley, ID 83274 Phone: 208-357-7611 Fax: 208-357-1805 |