Individual
TREVOR LARRY BYBEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
716 YELLOWSTONE AVE, POCATELLO, ID 83201-4407
(208) 478-1295
Mailing address
716 YELLOWSTONE AVE, POCATELLO, ID 83201-4407
(208) 478-1295
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4931
ID
Other
Enumeration date
06/05/2018
Last updated
06/05/2018
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