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General NPI Number Information
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NPI Number | 1780606616
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Entity Type | Organization
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Legal Business Name | BEARABLE DENTISTRY
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1410 S MAIN ST
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City | MOSCOW
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State | ID
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Zip | 83843-8930
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Country | US
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Telephone | 208-882-3214
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 S MAIN ST
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City | MOSCOW
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State | ID
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Zip | 83843-8930
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Country | US
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Telephone | 208-882-3214
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF INSURANCE COORDINATION
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Name | MRS. LINDA GORDON
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Credential | O.P.P.
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Telephone | 208-882-3214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | ID
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