# BLACKROCK DENTAL PARTNERS, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blackrock Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356643308
- **Authorized official:** JOSHUA R. GIBBONS DDS (OWNER)
- **Authorized official phone:** (208) 232-5294

## Contact information

- **Practice address:** 1606 E. CENTER ST., POCATELLO, ID 83201-4007
- **Practice address phone:** (208) 232-5294
- **Practice address fax:** (208) 233-5188
- **Mailing address:** 1606 E. CENTER ST., POCATELLO, ID 83201-4007
- **Mailing address phone:** (208) 232-5294
- **Mailing address fax:** (208) 233-5188

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4330 | ID | Yes |

## Other

- **Enumeration date:** 11/24/2010
- **Last updated:** 11/27/2019