Portneuf Dental Pllc

NPI #1669847596 in Pocatello, Idaho

Provider Information

NPI Number: 1669847596
Entity Type: Organization
Organization Name: Portneuf Dental Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 3, 2015
Last Updated: Feb 2, 2016

Practice Location

Address: 115 S 15TH AVE
Address 2: SUITE #E
City: Pocatello
State: Idaho
ZIP Code: 83201-4004
Phone: (208) 233-4310

Authorized Official

Name: DARCY JO HOCHSTRASSER
Title: OFFICE MANAGER
Phone: (208) 233-4310

Specialties & Taxonomy Codes

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

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