Backcountry Dental Docs, Llc

LBN: Backcountry Dental Docs, Llc
Backcountry Dental Docs, Llc is an health care organization with primary practice located at 109 Mckinley Ave , Kellogg ID 83837-2501. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Ambulatory Health Care Facilities / Dental. Dental Providers / Dentist is the primary health care specialty. Backcountry Dental Docs, Llc can be contacted via phone (208) 784-0545, or through Berry, Hillary Anne via phone (425) 409-1655.

Contact Information

Primary practice address
109 Mckinley Ave Kellogg ID 83837-2501
Phone: (208) 784-0545
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Berry, Hillary Anne Doctor of Dental Medicine (DMD)
Phone: (425) 409-1655

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X
Ambulatory Health Care Facilities / Dental 261QD0000X

Profile Details

NPI number 1235790510
LBN Legal business name Backcountry Dental Docs, Llc
DBA Doing business as
Authorized official Berry, Hillary Anne Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Jun 26th, 2019
Last updated Oct 3rd, 2022 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235790510 NPPES
Idaho MEDICAID 21014

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