| NPI | 1205175668 |
|---|---|
| Doing Business As | RIVERWEST DENTAL |
| Entity Type | Organization |
| Authorized Contact | MELISSA K RAICHART Insurance Coordinator 208-529-4484 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3971) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D3464) |
| 122300000X Dentist (Licence: ID D4302) | |
| 122300000X Dentist (Licence: ID D1719) | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-02-06 |