| Rufus O. Van Dyke, D.d.s., M.cl.d | |
|
1455 Bench Rd Suite A Pocatello ID 83201-5083 | |
| (208) 237-3330 | |
| Not Available |
| Full Name | Rufus O. Van Dyke, D.d.s., M.cl.d |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 1455 Bench Rd, Pocatello, Idaho |
| Authorized Official Name and Position | Tracy Van Dyke (OFFICE MANAGER) |
| Authorized Official Contact | 2082373330 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rufus O. Van Dyke, D.d.s., M.cl.d 1455 Bench Rd Suite A Pocatello ID 83201-5083 Ph: () - | Rufus O. Van Dyke, D.d.s., M.cl.d 1455 Bench Rd Suite A Pocatello ID 83201-5083 Ph: (208) 237-3330 |
| NPI Number | 1487802096 |
|---|---|
| Provider Enumeration Date | 09/08/2008 |
| Last Update Date | 09/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487802096 | NPI | - | NPPES |
| 9211318 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | D-3206-OR (Idaho) | Primary |
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