Provider Demographics
NPI:1518683598
Name:PRIEST RIVER DENTAL CARE
Entity Type:Organization
Organization Name:PRIEST RIVER DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-448-2694
Mailing Address - Street 1:6509 HIGHWAY 2 STE 102
Mailing Address - Street 2:
Mailing Address - City:PRIEST RIVER
Mailing Address - State:ID
Mailing Address - Zip Code:83856-6609
Mailing Address - Country:US
Mailing Address - Phone:208-448-2694
Mailing Address - Fax:208-448-1703
Practice Address - Street 1:6509 HIGHWAY 2 STE 102
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-6609
Practice Address - Country:US
Practice Address - Phone:208-448-2694
Practice Address - Fax:208-448-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty