Organization
BLACKROCK DENTAL PARTNERS, PLLC
Active
Other names
Blackrock Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA R. GIBBONS DDS (OWNER)
(208) 232-5294
Entity
Organization
Contact information
Practice address
1606 E. CENTER ST., POCATELLO, ID 83201-4007
(208) 232-5294
(208) 233-5188
Mailing address
1606 E. CENTER ST., POCATELLO, ID 83201-4007
(208) 232-5294
(208) 233-5188
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4330
ID
Other
Enumeration date
11/24/2010
Last updated
11/27/2019
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