Organization
DENTURE CLINIC OF POCATELLO, INC.
Active
Parent organization
DENTURE CLINIC OF POCATELLO, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTURE CLINIC OF POCATELLO, INC.
Authorized official
MR. GENO ALAN GIOVANINI L.D (OWNER)
(208) 232-2558
Entity
Organization
Contact information
Practice address
115 S 15TH AVE STE D, POCATELLO, ID 83201-4052
(208) 232-2558
(208) 232-2558
Mailing address
115 S 15TH AVE STE D, POCATELLO, ID 83201-4052
(208) 232-2558
(208) 232-2558
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
LD-98
ID
Other
Enumeration date
12/03/2013
Last updated
12/03/2013
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