| NPI | 1851516256 |
|---|---|
| Doing Business As | POCATELLO FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | BRIAN ROBERT CRAWFORD Program Director Iagd 208-282-5275 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2008-03-24 |