| Organization Name: | MOUNTAIN VIEW DENTAL CLINIC |
| NPI Number: | 1710158886 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY H WALKER (OWNER) |
| Mailing Address: | 390 South 3rd West Soda Springs |
| State: | ID US |
| Postal Code: | 83276 |
| Phone Number: | 2085472220 |
| Fax Number: | 2085472224 |
| NPI Enumeration Date: | 03/17/2008 |
| NPI Last Update Date: | 05/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D3839 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |