Individual
DR. CASETIN WADE LYBBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 282-6000
Mailing address
4170 HAWTHORNE RD, CHUBBUCK, ID 83202-2707
(208) 816-6278
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D-5415
ID
1223G0001X
General Practice Dentistry
Primary
D-5415
ID
Other
Enumeration date
06/15/2022
Last updated
06/15/2022
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