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Organization
RUSSELL C. POOL, DMD, PA
Active
Organization
RUSSELL C. POOL, DMD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL C. POOL DMD (PRESIDENT)
(208) 467-2545
Entity
Organization
Contact information
Practice address
109 12TH AVE RD, NAMPA, ID 83686-5047
(208) 467-2545
(208) 466-3607
Mailing address
109 12TH AVE RD, NAMPA, ID 83686-5047
(208) 467-2545
(208) 466-3607
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D1687
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
66852
BLUE SHIELD OF IDAHO
ID
Enumeration date
06/25/2008
Last updated
06/25/2008
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