Family Dental of Blackfoot LLC

NPI #1205208162 in Blackfoot, Idaho

Provider Information

NPI Number: 1205208162
Entity Type: Organization
Organization Name: Family Dental of Blackfoot LLC
Primary Specialty: Dentist
Enumeration Date: Oct 30, 2015
Last Updated: Oct 30, 2015

Practice Location

Address: 2407 TEEPLES DR
City: Blackfoot
State: Idaho
ZIP Code: 83221-5877
Phone: (208) 782-0242

Authorized Official

Name: DR. BRYCE BURTENSHAW
Title: OWNER
Phone: (208) 782-0242

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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