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General NPI Number Information
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NPI Number | 1699117440
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Entity Type | Organization
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Legal Business Name | R.C. ENTERPRISE, P.L.L.C.
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 105 E 10TH AVE
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City | POST FALLS
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State | ID
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Zip | 83854-5125
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Country | US
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Telephone | 208-773-8388
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Fax | 208-777-0346
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Provider Business Mailing Address
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Address Line | 105 E 10TH AVE
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City | POST FALLS
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State | ID
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Zip | 83854-5125
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Country | US
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Telephone | 208-773-8388
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Fax | 208-777-0346
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RHEANNA R. BURNHAM
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Credential | DMD
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Telephone | 208-773-8388
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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 | D4332
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License Number State | ID
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