Id Specialty Dental Services, Pllc

NPI #1013757830 in Pocatello, Idaho

Provider Information

NPI Number
1013757830
Entity Type
Organization
Organization Name
Id Specialty Dental Services, Pllc
Subpart
Yes (part of a larger organization)
Parent Organization
ID SPECIALTY DENTAL SERVICES, PLLC
Primary Specialty
Dentist - Orthodontics and Dentofacial Orthopedics
Enumeration Date
May 29, 2024
Last Updated
May 29, 2024

Practice Location

Address
625 E ALAMEDA RD
State
Idaho
ZIP Code
83201-3622
Phone
(208) 237-0005

Authorized Official

Name
CHARLOTTE DASCH
Title
DIRECTOR OF CRED AND PROV REL
Phone
(504) 638-0303

Specialties & Taxonomy Codes

Specialty
Dentist - Orthodontics and Dentofacial OrthopedicsOrthodontics and Dentofacial Orthopedics

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