BACKCOUNTRY DENTAL DOCS, LLC
NPI: 1235790510
· KELLOGG, ID 83837
· Dental Clinic/Center
· NPI assigned 06/26/2019
$398.50
Total Medicaid Paid
Provider Details
| Authorized Official | BERRY, HILLARY (MANAGER) |
| NPI Enumeration Date | 06/26/2019 |
Related Entities
Other providers sharing the same authorized official: BERRY, HILLARY
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2020 |
20 |
$398.50 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
20 |
16 |
$398.50 |