Organization
CHILDREN'S DENTISTRY OF POCATELLO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSS N HUGUES DDS (OFFICER)
(208) 238-1165
Entity
Organization
Contact information
Practice address
425 E ALAMEDA RD, POCATELLO, ID 83201-3609
(208) 238-1165
(208) 238-1241
Mailing address
425 E ALAMEDA RD, POCATELLO, ID 83201-3609
(208) 238-1165
(208) 238-1241
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D3679
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807788200
—
ID
Enumeration date
06/06/2008
Last updated
08/20/2014
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