Organization
MCKEE IDAHO DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL CLARK DMD, MD (OWNER)
(208) 232-6400
Entity
Organization
Contact information
Practice address
1541 E CLARK ST, POCATELLO, ID 83201-4100
(208) 232-6400
(208) 232-6050
Mailing address
1541 E CLARK STREET, POCATELLO, ID 83201-4100
(208) 232-6400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
12/04/2024
Last updated
12/09/2024
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