# MCKEE IDAHO DENTAL

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

## Provider details

- **NPI number:** 1972319085
- **Authorized official:** DR. PAUL CLARK DMD, MD (OWNER)
- **Authorized official phone:** (208) 232-6400

## Contact information

- **Practice address:** 1541 E CLARK ST, POCATELLO, ID 83201-4100
- **Practice address phone:** (208) 232-6400
- **Practice address fax:** (208) 232-6050
- **Mailing address:** 1541 E CLARK STREET, POCATELLO, ID 83201-4100
- **Mailing address phone:** (208) 232-6400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 12/04/2024
- **Last updated:** 12/09/2024