Organization
MODERN SMILES POCATELLO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE FRANK (CREDENTIALING COORDINATOR)
(509) 570-6879
Entity
Organization
Contact information
Practice address
1800 FLANDRO DR STE 340, POCATELLO, ID 83202-4944
(208) 238-1900
Mailing address
1800 FLANDRO DR STE 340, POCATELLO, ID 83202-4944
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/13/2022
Last updated
02/10/2023
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