# ALLIED DENTAL CLINIC, PC

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

## Provider details

- **NPI number:** 1790999407
- **Authorized official:** RANDALL C SNOW DMD (OWNER)
- **Authorized official phone:** (208) 237-0563

## Contact information

- **Practice address:** 1246 YELLOWSTONE AVE STE B3, POCATELLO, ID 83201-4372
- **Practice address phone:** (208) 237-0563
- **Mailing address:** 1246 YELLOWSTONE AVE STE B3, POCATELLO, ID 83201-4372
- **Mailing address phone:** (208) 237-0563

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3171 | ID | Yes |

## Other

- **Enumeration date:** 05/10/2007
- **Last updated:** 08/22/2020