| Pocatello Family Dentistry | |
|
465 Memorial Dr. Pocatello ID 83209-8088 | |
| (208) 282-6000 | |
| (208) 282-4950 |
| Full Name | Pocatello Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 465 Memorial Dr., Pocatello, Idaho |
| Authorized Official Name and Position | Brian Robert Crawford (PROGRAM DIRECTOR IAGD) |
| Authorized Official Contact | 2082825275 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pocatello Family Dentistry 921 S. 8th Ave., Stop 8088 Pocatello ID 83209-8088 Ph: (208) 282-6000 | Pocatello Family Dentistry 465 Memorial Dr. Pocatello ID 83209-8088 Ph: (208) 282-6000 |
| NPI Number | 1851516256 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 03/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851516256 | NPI | - | NPPES |
| 181764 | Medicaid | ID | |
| 8057101 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Idaho) | Primary |
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