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General NPI Number Information
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NPI Number | 1376792275
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Entity Type | Organization
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Legal Business Name | SUN VALLEY DENTAL GROUP LLC
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 181 NORTH FIRST AVENUE
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City | KETCHUM
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State | ID
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Zip | 83340
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Country | US
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Telephone | 208-726-4711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3360
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City | KETCHUM
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State | ID
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Zip | 83340-3360
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Country | US
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Telephone | 208-726-4711
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Fax | 208-726-6251
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. BRIAN CAMERON GALBRAITH
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Credential | DDS
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Telephone | 208-726-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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