| Center For Dental Excellence Llc | |
|
1525 Baldy Ave Pocatello ID 83201-7117 | |
| (208) 238-0011 | |
| (208) 904-3843 |
| Full Name | Center For Dental Excellence Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1525 Baldy Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Jeremy L Hodge (OWNER) |
| Authorized Official Contact | 2082380011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Dental Excellence Llc 1525 Baldy Ave Pocatello ID 83201-7117 Ph: (208) 238-0011 | Center For Dental Excellence Llc 1525 Baldy Ave Pocatello ID 83201-7117 Ph: (208) 238-0011 |
| NPI Number | 1376852939 |
|---|---|
| Provider Enumeration Date | 09/30/2010 |
| Last Update Date | 11/18/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376852939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D3808 (Idaho) | Primary |
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