Organization
RUFUS O. VAN DYKE, D.D.S., M.CL.D
Active
Organization
RUFUS O. VAN DYKE, D.D.S., M.CL.D
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY VAN DYKE (OFFICE MANAGER)
(208) 237-3330
Entity
Organization
Contact information
Practice address
1455 BENCH RD, SUITE A, POCATELLO, ID 83201-5083
(208) 237-3330
Mailing address
1455 BENCH RD, SUITE A, POCATELLO, ID 83201-5083
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-3206-OR
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9211318
—
ID
Enumeration date
09/08/2008
Last updated
09/08/2008
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