| Rockhouse Dentistry | |
|
106 E 1st North Rexburg ID 83440 | |
| (208) 356-5600 | |
| (208) 419-0202 |
| Full Name | Rockhouse Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 106 E 1st North, Rexburg, Idaho |
| Authorized Official Name and Position | James Cannon Allen (DENTIST) |
| Authorized Official Contact | 2083565600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockhouse Dentistry 106 E 1st North Rexburg ID 83440 Ph: (208) 356-5600 | Rockhouse Dentistry 106 E 1st North Rexburg ID 83440 Ph: (208) 356-5600 |
| NPI Number | 1033461660 |
|---|---|
| Provider Enumeration Date | 10/05/2012 |
| Last Update Date | 10/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033461660 | NPI | - | NPPES |
| 9201769 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D-3634 (Idaho) | Primary |
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