| NPI | 1851627103 |
|---|---|
| Doing Business As | MOUNTAIN LAKE DENTAL |
| Entity Type | Organization |
| Authorized Contact | SHERRY M CORBRIDGE Corporate Secretary 208-265-1705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2026-01-28 |