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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