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GRAND TETON DENTAL CARE

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Company Details

Name: GRAND TETON DENTAL CARE
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 22 Jul 2010 (15 years ago)
Entity Number: 429575
Place of Formation: IDAHO
File Number: 0000429575
ZIP code: 83455
County: Teton County
Mailing Address: PO BOX 919 VICTOR, ID 83455

National Provider Identifier

NPI Number:
1336457837

Authorized Person:

Name:
DR. ELMER RAYMOND CHERRY IV
Role:
OWNER
Phone:

Taxonomy:

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

Contacts:

Fax:
2087872464

Filing

Filing Name Filing Number Filing date
Initial Filing 0000429575 2010-07-22

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Date of last update: 25 Sep 2024

Sources: Idaho Secretary of State