Organization
CHILDREN'S DENTISTRY OF POCATELLO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSS HUGUES DDS (OWNER)
(208) 238-1165
Entity
Organization
Contact information
Practice address
425 E ALAMEDA RD, POCATELLO, ID 83201-3609
(208) 238-1165
(208) 238-1241
Mailing address
425 E ALAMEDA RD, POCATELLO, ID 83201-3609
(208) 238-1165
(208) 238-1241
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D3679PD
ID
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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