Organization
OLYMPUS FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD E FELLOWS D.D.S. (OWNER)
(208) 237-4357
Entity
Organization
Contact information
Practice address
1598 DELPHIC WAY STE B, POCATELLO, ID 83201-2200
(208) 237-4357
(208) 237-1418
Mailing address
1598 DELPHIC WAY STE B, POCATELLO, ID 83201-2200
(208) 237-4357
(208) 237-1418
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3406
ID
Other
Enumeration date
06/05/2008
Last updated
06/05/2008
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