Valley Dental Pa

NPI 1114067105 - Dentist - 1223P0221X

NPI Details
NPI 1114067105
Enumeration Date 02/07/2007
Last Updated 07/09/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name LARRY W LARRY
Position OWNER
Phone (208) 478-5437
Fax (208) 232-5490
Practice Location
716 YELLOWSTONE AVE
POCATELLO ID, 83201-4407, US
Phone (208) 478-5437
Fax (208) 232-5490
Business Location
716 YELLOWSTONE AVE
POCATELLO ID, 83201-4407, US
Phone (208) 478-5437
Fax (208) 232-5490
Toxanomy
Taxonomy Code 1223P0221X
License State Idaho
License Number D1664
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According to our database, Valley Dental Pa NPI is 1114067105, taxonomy code is 1223P0221X and license number is D1664, license state is located at Idaho. Valley Dental Pa physically located at 716 Yellowstone Ave, Pocatello ID, 83201-4407. NPI Number 1033115704 has the healthcare provider type.

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1114067105 NPI number is provided on an as is basis without warranty of any kind. 1114067105 is maintained by the National Plan & Provider Enumeration System. The contents of Valley Dental Pa are for informational purposes only.