Individual
BRENT WILLIAM CLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
675 YELLOWSTONE AVE, POCATELLO, ID 83201-4511
(208) 478-5700
Mailing address
467 PHEASANT RIDGE DR APT B, POCATELLO, ID 83202-1755
(208) 201-5780
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4930
ID
Other
Enumeration date
06/18/2018
Last updated
06/18/2018
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