| Id Specialty Dental Services, Pllc | |
|
625 E Alameda Rd Pocatello ID 83201-3622 | |
| (208) 237-0005 | |
| Not Available |
| Full Name | Id Specialty Dental Services, Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 625 E Alameda Rd, Pocatello, Idaho |
| Authorized Official Name and Position | Charlotte Dasch (DIRECTOR OF CRED AND PROV REL) |
| Authorized Official Contact | 5046380303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Id Specialty Dental Services, Pllc 1610 54th Ave N Ste 205 Nashville TN 37209-1442 Ph: (615) 678-0759 | Id Specialty Dental Services, Pllc 625 E Alameda Rd Pocatello ID 83201-3622 Ph: (208) 237-0005 |
| NPI Number | 1013757830 |
|---|---|
| Provider Enumeration Date | 05/29/2024 |
| Last Update Date | 05/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013757830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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