# OLYMPUS FAMILY DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306005236
- **Authorized official:** DR. RICHARD E FELLOWS D.D.S. (OWNER)
- **Authorized official phone:** (208) 237-4357

## Contact information

- **Practice address:** 1598 DELPHIC WAY STE B, POCATELLO, ID 83201-2200
- **Practice address phone:** (208) 237-4357
- **Practice address fax:** (208) 237-1418
- **Mailing address:** 1598 DELPHIC WAY STE B, POCATELLO, ID 83201-2200
- **Mailing address phone:** (208) 237-4357
- **Mailing address fax:** (208) 237-1418

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3406 | ID | Yes |

## Other

- **Enumeration date:** 06/05/2008
- **Last updated:** 06/05/2008