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WEST RIVER DENTAL

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Company Details

Name: WEST RIVER DENTAL
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 10 Aug 2006 (19 years ago)
Entity Number: 316993
Place of Formation: IDAHO
File Number: 0000316993
ZIP code: 83402
County: Bonneville County
Mailing Address: 250 SKYLINE DR STE 6 IDAHO FALLS, ID 83402

National Provider Identifier

NPI Number:
1295478519
Certification Date:
2022-04-14

Authorized Person:

Name:
DAN R. GREENHALGH
Role:
OWNER DOCTOR
Phone:

Taxonomy:

Selected Taxonomy:
261QD0000X - Dental Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2085233458

Filing

Filing Name Filing Number Filing date
Initial Filing 0000316993 2006-08-10

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State