Organization
CENTER FOR DENTAL EXCELLENCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY L HODGE DMD (OWNER)
(208) 238-0011
Entity
Organization
Contact information
Practice address
1525 BALDY AVE, POCATELLO, ID 83201-7117
(208) 238-0011
(208) 904-3843
Mailing address
1525 BALDY AVE, POCATELLO, ID 83201-7117
(208) 238-0011
(208) 904-3843
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D3808
ID
Other
Enumeration date
09/30/2010
Last updated
11/18/2010
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