Organization
VALLEY DENTAL PA
Active
Other names
Kidds Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY W BYBEE DDS (OWNER)
(208) 478-5437
Entity
Organization
Contact information
Practice address
716 YELLOWSTONE AVE, POCATELLO, ID 83201-4407
(208) 478-5437
(208) 232-5490
Mailing address
716 YELLOWSTONE AVE, POCATELLO, ID 83201-4407
(208) 478-5437
(208) 232-5490
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D1664
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806808800
—
ID
05
—
806808801
—
ID
Enumeration date
02/07/2007
Last updated
11/30/2016
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