Individual
SCOTT CHARLES GRILLIOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
921 S 8TH AVE STOP 8088, POCATELLO, ID 83209-4008
(208) 282-1040
(208) 282-1040
Mailing address
1500 E VENTURE WAY APT 3104, POCATELLO, ID 83201-1203
(309) 830-5306
(208) 282-1040
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-5639
ID
Other
Enumeration date
06/13/2024
Last updated
06/24/2024
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