NPI 1609113455

Stone Ridge Dental P.C.

Organisation Preferred Provider Organization Blackfoot, ID

Practice location

Address: 380 W Judicial St, Blackfoot, ID 83221-2122
Phone: (208) 785-6833

Authorised official

Name: Curtis Carpenter
Title: President
Phone: (208) 357-7900

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: 1609113455
Entity type: Organization
NPI issued: 14 Jan 2013
Record last updated: 14 Jan 2013

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.