Four Season Dental PC

NPI #1215102439 in Pocatello, Idaho

Provider Information

NPI Number: 1215102439
Entity Type: Organization
Organization Name: Four Season Dental PC
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 29, 2008
Last Updated: Apr 29, 2008

Practice Location

Address: 115 E CHAPEL RD
City: Pocatello
State: Idaho
ZIP Code: 83201
Phone: (208) 237-6848

Authorized Official

Name: LIZ JOHN
Title: OFFICE MANAGER
Phone: (208) 237-6848

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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