Organization
O-BAR FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JED C. SNOW D.M.D. (DOCTOR/OWNER)
(208) 588-3316
Entity
Organization
Contact information
Practice address
304 SO MAIN, MACKAY, ID 83251
(208) 588-3316
(208) 588-3166
Mailing address
P.O. BOX 86, MACKAY, ID 83251
(208) 588-3316
(208) 588-3166
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D4109
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9203474
IDAHO SMILES
ID
Enumeration date
04/02/2008
Last updated
04/02/2008
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