| Blackrock Dental | |
|
1606 E. Center St. Pocatello ID 83201-4007 | |
| (208) 232-5294 | |
| (208) 233-5188 |
| Full Name | Blackrock Dental |
|---|---|
| Speciality | Dentist |
| Location | 1606 E. Center St., Pocatello, Idaho |
| Authorized Official Name and Position | Joshua R. Gibbons (OWNER) |
| Authorized Official Contact | 2082325294 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackrock Dental 1606 E. Center St. Pocatello ID 83201-4007 Ph: (208) 232-5294 | Blackrock Dental 1606 E. Center St. Pocatello ID 83201-4007 Ph: (208) 232-5294 |
| NPI Number | 1356643308 |
|---|---|
| Provider Enumeration Date | 11/24/2010 |
| Last Update Date | 11/27/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356643308 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D4330 (Idaho) | Primary |
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