Individual
BRYANT DUDZIK
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
465 MEMORIAL DR, POCATELLO, ID 83201-4008
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4852
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D4852
—
ID
Enumeration date
08/14/2017
Last updated
08/14/2017
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