Riverside Dental PC

NPI #1053321885 in Blackfoot, Idaho

Provider Information

NPI Number: 1053321885
Entity Type: Organization
Organization Name: Riverside Dental PC
Primary Specialty: Dentist
Enumeration Date: Aug 8, 2006
Last Updated: Jul 30, 2008

Practice Location

Address: 1120 PARKWAY DR
City: Blackfoot
State: Idaho
ZIP Code: 83221
Phone: (208) 785-0878

Authorized Official

Name: DR. BRADFORD WILLIAM HARPER, DDS
Title: OWNER/PRESIDENT
Phone: (208) 785-0878

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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