| Four Season Dental Pc | |
|
115 E Chapel Rd Pocatello ID 83201 | |
| (208) 237-6848 | |
| (208) 237-6811 |
| Full Name | Four Season Dental Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 115 E Chapel Rd, Pocatello, Idaho |
| Authorized Official Name and Position | Liz John (OFFICE MANAGER) |
| Authorized Official Contact | 2082376848 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Four Season Dental Pc 115 E Chapel Rd Pocatello ID 83201 Ph: (208) 237-6848 | Four Season Dental Pc 115 E Chapel Rd Pocatello ID 83201 Ph: (208) 237-6848 |
| NPI Number | 1215102439 |
|---|---|
| Provider Enumeration Date | 04/29/2008 |
| Last Update Date | 04/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215102439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D1967 (Idaho) | Primary |
| 1223G0001X | Dentist - General Practice | D3808 (Idaho) | Secondary |
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