Provider Demographics
NPI:1699117440
Name:R.C. ENTERPRISE, P.L.L.C.
Entity type:Organization
Organization Name:R.C. ENTERPRISE, P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHEANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-773-8388
Mailing Address - Street 1:105 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5125
Mailing Address - Country:US
Mailing Address - Phone:208-773-8388
Mailing Address - Fax:208-777-0346
Practice Address - Street 1:105 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5125
Practice Address - Country:US
Practice Address - Phone:208-773-8388
Practice Address - Fax:208-777-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4332122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty