| NPI | 1336309475 |
|---|---|
| Former Legal Business Name | WIND RIVER DENTAL LLC |
| Entity Type | Organization |
| Authorized Contact | MATTHEW D GEDDES Member 208-432-2025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WY 1169) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2019-12-28 |