| Family Dental Of Blackfoot Llc | |
|
2407 Teeples Dr Blackfoot ID 83221-5877 | |
| (208) 782-0242 | |
| (208) 782-1160 |
| Full Name | Family Dental Of Blackfoot Llc |
|---|---|
| Speciality | Dentist |
| Location | 2407 Teeples Dr, Blackfoot, Idaho |
| Authorized Official Name and Position | Bryce Burtenshaw (OWNER) |
| Authorized Official Contact | 2087820242 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dental Of Blackfoot Llc 2407 Teeples Dr Blackfoot ID 83221-5877 Ph: (208) 782-0242 | Family Dental Of Blackfoot Llc 2407 Teeples Dr Blackfoot ID 83221-5877 Ph: (208) 782-0242 |
| NPI Number | 1205208162 |
|---|---|
| Provider Enumeration Date | 10/30/2015 |
| Last Update Date | 10/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205208162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D-3614 (Idaho) | Primary |
| 122300000X | Dentist | D-3830 (Idaho) | Secondary |
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Peggy J Trebilcock Dds Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2407 Teeples Dr, Blackfoot, ID 83221 Phone: 208-782-0242 Fax: 208-782-1160 | |
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