NPI 1558512277

Stone Ridge Dental INC.

Organisation Preferred Provider Organization Shelley, ID

Practice location

Address: 1035 October Cv, Shelley, ID 83274-5068
Phone: (208) 357-0307
Mailing address: 295 Anderson Road, Shelley, ID 83274

Authorised official

Name: Curtis Carpenter
Title: Owner
Phone: (208) 346-7045

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence D-4169 (ID)

Other Preferred Provider Organization providers in Idaho →

Registry record

NPI: 1558512277
Entity type: Organization
NPI issued: 1 Oct 2008
Record last updated: 1 Oct 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.