| Portneuf Valley Dental | |
|
1246 Yellowstone Ave Pocatello ID 83201-4374 | |
| (208) 238-0125 | |
| Not Available |
| Full Name | Portneuf Valley Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1246 Yellowstone Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Jayson Anders Bird (CEO/OWNER) |
| Authorized Official Contact | 2086805144 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Portneuf Valley Dental 1246 Yellowstone Ave Pocatello ID 83201-4374 Ph: (208) 238-0125 | Portneuf Valley Dental 1246 Yellowstone Ave Pocatello ID 83201-4374 Ph: (208) 238-0125 |
| NPI Number | 1770127565 |
|---|---|
| Provider Enumeration Date | 11/05/2019 |
| Last Update Date | 11/05/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770127565 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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