Provider Demographics
NPI:1043633712
Name:NEERINGS DENTAL INC, DBA TETON VALLEY DENTAL CENTER
Entity Type:Organization
Organization Name:NEERINGS DENTAL INC, DBA TETON VALLEY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:REED
Authorized Official - Last Name:NEERINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-354-8181
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-0791
Mailing Address - Country:US
Mailing Address - Phone:208-354-8181
Mailing Address - Fax:208-354-8182
Practice Address - Street 1:235 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422
Practice Address - Country:US
Practice Address - Phone:208-354-8181
Practice Address - Fax:208-354-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty