Organization
CARE CREEK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL A. GAGNON DMD (DENTIST/OWNER)
(208) 233-8620
Entity
Organization
Contact information
Practice address
1169 CALL CREEK DR STE A, POCATELLO, ID 83201-3077
(208) 233-8620
Mailing address
1169 CALL CREEK DR STE A, POCATELLO, ID 83201-3077
(208) 233-8620
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3946
ID
Other
Enumeration date
04/09/2009
Last updated
04/09/2009
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