| Tooth Town | |
|
625 E Alameda Rd. Pocatello ID 83201 | |
| (208) 237-1567 | |
| (208) 478-5097 |
| Full Name | Tooth Town |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 625 E Alameda Rd., Pocatello, Idaho |
| Authorized Official Name and Position | Robert D. Mcwhorter (PRESIDENT) |
| Authorized Official Contact | 2082371567 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tooth Town 625 E Alameda Rd. Pocatello ID 83201 Ph: (208) 237-1567 | Tooth Town 625 E Alameda Rd. Pocatello ID 83201 Ph: (208) 237-1567 |
| NPI Number | 1679812002 |
|---|---|
| Provider Enumeration Date | 02/05/2013 |
| Last Update Date | 02/05/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679812002 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D-3451-PD (Idaho) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | D-4186-PD (Idaho) | Secondary |
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