McKee Idaho Dental
Dentist in Pocatello, ID. Organization (NPI-2).
NPI number1972319085
StatusActive
Last updated in NPPESDec 9, 2024
Details
- NPI
- 1972319085
- Entity type
- Organization (NPI-2)
- Legal business name
- McKee Idaho Dental
- Organization subpart
- No
- Enumeration date
- Dec 4, 2024
- Certification date
- Dec 9, 2024
- Last updated
- Dec 9, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | – | – | Yes |
Practice location
1541 E Clark StPocatello, ID 83201-4100
Phone 208-232-6400 · Fax 208-232-6050
Mailing address
1541 E Clark StreetPocatello, ID 83201-4100
Phone 208-232-6400
Authorized official
Paul Clark
Owner
2082326400
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